- Enrollment id
- O20230404002753
- Enrollment state
- CA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1730892357
- Multiple npi flag
- N
- Ccn
- 056180
- Associate id
- 6901271998
- Organization name
- NIGHTFALL HEALTHCARE INC
- Doing business as name
- LAKE BALBOA CARE CENTER
- Incorporation date
- 2022-11-08
- Incorporation state
- NV
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Nursing home provider name
- LAKE BALBOA CARE CENTER
- Affiliation entity name
- THE ENSIGN GROUP
- Affiliation entity id
- 507
- Address line 1
- 16955 VANOWEN ST
- City
- VAN NUYS
- State
- CA
- Zip code
- 914064542