- Enrollment id
- O20150526000706
- Enrollment state
- CA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1396122297
- Multiple npi flag
- N
- Ccn
- 555067
- Associate id
- 4789904202
- Organization name
- MCCLUREIDENCE OPCO, LLC
- Doing business as name
- MCCLURE POST ACUTE
- Incorporation date
- 2014-09-25
- Incorporation state
- CA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- MCCLURE POST ACUTE
- Affiliation entity name
- PACS GROUP
- Affiliation entity id
- 690
- Address line 1
- 2910 MCCLURE ST
- City
- OAKLAND
- State
- CA
- Zip code
- 946093505