- Enrollment id
- O20171218003140
- Enrollment state
- CA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1437607926
- Multiple npi flag
- N
- Ccn
- 555912
- Associate id
- 6901164060
- Organization name
- BAKERSFIELDIDENCE OPCO LLC
- Doing business as name
- KERN RIVER TRANSITIONAL CARE
- Incorporation date
- 2016-09-06
- Incorporation state
- CA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- KERN RIVER TRANSITIONAL CARE
- Affiliation entity name
- PACS GROUP
- Affiliation entity id
- 690
- Address line 1
- 5151 KNUDSEN DR
- City
- BAKERSFIELD
- State
- CA
- Zip code
- 933087199