- Enrollment id
- O20110906000232
- Enrollment state
- CA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1548283542
- Multiple npi flag
- N
- Ccn
- 055039
- Associate id
- 9133399926
- Organization name
- STOCKTON EDISON HEALTHCARE CORPORATION
- Doing business as name
- GOOD SAMARITAN REHABILITATION AND CARE CENTER
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Nursing home provider name
- GOOD SAMARITAN REHAB AND CARE CENTER
- Address line 1
- 1630 N EDISON ST
- City
- STOCKTON
- State
- CA
- Zip code
- 952045633