- Enrollment id
- O20040916000836
- Enrollment state
- CA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1770564114
- Multiple npi flag
- N
- Ccn
- 555199
- Associate id
- 3173590221
- Organization name
- GR8 CARE, INC.
- Doing business as name
- COAST CARE CONVALESCENT CENTER
- Incorporation date
- 2004-03-16
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Nursing home provider name
- COAST CARE CONVALESCENT CENTER
- Address line 1
- 14518 LOS ANGELES ST
- City
- BALDWIN PARK
- State
- CA
- Zip code
- 917062636