- Enrollment id
- O20050822001242
- Enrollment state
- CA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1578521274
- Multiple npi flag
- N
- Ccn
- 056105
- Associate id
- 9830120682
- Organization name
- BALBOA HEALTHCARE, INC.
- Doing business as name
- BALBOA NURSING & REHABILITATION CENTER
- Incorporation date
- 2005-07-14
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Nursing home provider name
- BALBOA NURSING & REHABILITATION CENTER
- Affiliation entity name
- PACS GROUP
- Affiliation entity id
- 690
- Address line 1
- 3520 4TH AVE
- City
- SAN DIEGO
- State
- CA
- Zip code
- 921034913