- Enrollment id
- O20100616000271
- Enrollment state
- CA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1497077739
- Multiple npi flag
- N
- Ccn
- 056079
- Associate id
- 9436289584
- Organization name
- GLENDORA GRAND, INC.
- Doing business as name
- N/A
- Incorporation date
- 2008-07-27
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Nursing home provider name
- GLENDORA GRAND, INC
- Affiliation entity name
- ROLLINS-NELSON HEALTHCARE MANAGEMENT
- Affiliation entity id
- 456
- Address line 1
- 805 W ARROW HWY
- City
- GLENDORA
- State
- CA
- Zip code
- 917405413