- Enrollment id
- O20180216000750
- Enrollment state
- CA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1649787268
- Multiple npi flag
- N
- Ccn
- 055107
- Associate id
- 3173883931
- Organization name
- BANCROFT HEALTH GROUP INC.
- Doing business as name
- BANCROFT HEALTHCARE CENTER
- Incorporation date
- 2017-08-16
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Nursing home provider name
- BANCROFT HEALTHCARE CENTER
- Address line 1
- 1475 BANCROFT AVE
- City
- SAN LEANDRO
- State
- CA
- Zip code
- 945775105