- Enrollment id
- O20111031000783
- Enrollment state
- CA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1780972463
- Multiple npi flag
- N
- Ccn
- 055318
- Associate id
- 8527231935
- Organization name
- SKYLINE SAN JOSE OPERATING COMPANY LP
- Doing business as name
- SKYLINE HEALTHCARE CENTER-SAN JOSE
- Organization type structure
- PARTNERSHIP
- Proprietary nonprofit
- P
- Nursing home provider name
- SKYLINE HEALTHCARE CENTER - SAN JOSE
- Affiliation entity name
- MARINER HEALTH CARE
- Affiliation entity id
- 334
- Address line 1
- 2065 FOREST AVE
- City
- SAN JOSE
- State
- CA
- Zip code
- 951284807