- Enrollment id
- O20140210000220
- Enrollment state
- CA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1588091383
- Multiple npi flag
- N
- Ccn
- 555251
- Associate id
- 3577792803
- Organization name
- KNOLLS WEST POST ACUTE LLC
- Incorporation date
- 2013-10-08
- Incorporation state
- CA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- KNOLLS WEST POST ACUTE LLC
- Affiliation entity name
- DAVID JOHNSON
- Affiliation entity id
- 851
- Address line 1
- 16890 GREEN TREE BLVD
- City
- VICTORVILLE
- State
- CA
- Zip code
- 923955618