- Enrollment id
- O20040707001575
- Enrollment state
- CA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1396732046
- Multiple npi flag
- N
- Ccn
- 056026
- Associate id
- 2961480900
- Organization name
- EMPRESS CARE CENTER, LLC
- Incorporation date
- 2001-09-01
- Incorporation state
- CA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- EMPRESS CARE CENTER, LLC
- Affiliation entity name
- EVA CARE GROUP
- Affiliation entity id
- 213
- Address line 1
- 1299 S BASCOM AVE
- City
- SAN JOSE
- State
- CA
- Zip code
- 951283514