- Enrollment id
- O20091228000286
- Enrollment state
- CA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1518063437
- Multiple npi flag
- N
- Ccn
- 555318
- Associate id
- 3971643826
- Organization name
- VILLA RANCHO BERNARDO HEALTH CARE LLC
- Doing business as name
- VILLA RANCHO BERNARDO CARE CENTER
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- VILLA RANCHO BERNARDO CARE CENTER
- Affiliation entity name
- DAVID JOHNSON
- Affiliation entity id
- 851
- Address line 1
- 15720 BERNARDO CENTER DR
- City
- SAN DIEGO
- State
- CA
- Zip code
- 921275861