- Enrollment id
- O20160203002793
- Enrollment state
- CA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1639548308
- Multiple npi flag
- N
- Ccn
- 056082
- Associate id
- 2769786201
- Organization name
- DRAGONFRUIT HOLDINGS LLC
- Doing business as name
- CANYON SPRINGS POST-ACUTE
- Incorporation date
- 2015-07-29
- Incorporation state
- DE
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- CANYON SPRINGS POST-ACUTE
- Affiliation entity name
- PACS GROUP
- Affiliation entity id
- 690
- Address line 1
- 180 N JACKSON AVE
- City
- SAN JOSE
- State
- CA
- Zip code
- 951161907