- Enrollment id
- O20040422000115
- Enrollment state
- CA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1699770867
- Multiple npi flag
- N
- Ccn
- 555461
- Associate id
- 3577559921
- Organization name
- MARINA GARDEN NURSING CENTER, INC.
- Doing business as name
- MARINA GARDEN NURSING CENTER
- Incorporation date
- 2004-03-26
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Nursing home provider name
- MARINA GARDEN NURSING CENTER
- Address line 1
- 3201 FERNSIDE BLVD.
- City
- ALAMEDA
- State
- CA
- Zip code
- 945011709