- Enrollment id
- O20070511000223
- Enrollment state
- ID
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1407956253
- Multiple npi flag
- N
- Ccn
- 135011
- Associate id
- 3173521176
- Organization name
- POCATELLO HEALTH SERVICES INC
- Doing business as name
- GATEWAY TRANSITIONAL CARE CENTER
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Nursing home provider name
- GATEWAY TRANSITIONAL CARE CENTER
- Affiliation entity name
- THE ENSIGN GROUP
- Affiliation entity id
- 507
- Address line 1
- 527 MEMORIAL DR
- City
- POCATELLO
- State
- ID
- Zip code
- 832014063