- Enrollment id
- O20161122000044
- Enrollment state
- CA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1801345772
- Multiple npi flag
- N
- Ccn
- 056350
- Associate id
- 6204115918
- Organization name
- LAKE MERRITT HEALTHCARE CENTER LLC
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- LAKE MERRITT HEALTHCARE CENTER LLC
- Affiliation entity name
- CRYSTAL SOLORZANO
- Affiliation entity id
- 752
- Address line 1
- 309 MACARTHUR BLVD
- City
- OAKLAND
- State
- CA
- Zip code
- 946103233