- Enrollment id
- O20200218001900
- Enrollment state
- ME
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1528610433
- Multiple npi flag
- N
- Ccn
- 205082
- Associate id
- 7214364991
- Organization name
- PINNACLE GROUP OF HUDSON VALLEY II LLC
- Incorporation date
- 2019-01-14
- Incorporation state
- ME
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- PINNACLE HEALTH & REHAB AT SANFORD
- Address line 1
- 1142 MAIN ST
- City
- SANFORD
- State
- ME
- Zip code
- 040733614