- Enrollment id
- O20111220000085
- Enrollment state
- CA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1396029724
- Multiple npi flag
- N
- Ccn
- 555099
- Associate id
- 1052586146
- Organization name
- THE HEALTHCARE CENTER OF DOWNEY LLC
- Doing business as name
- LAKEWOOD HEALTHCARE CENTER
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- LAKEWOOD HEALTHCARE CENTER
- Affiliation entity name
- PACIFIC HEALTHCARE HOLDINGS
- Affiliation entity id
- 792
- Address line 1
- 12023 LAKEWOOD BLVD
- City
- DOWNEY
- State
- CA
- Zip code
- 902422635