- Enrollment id
- O20201005001392
- Enrollment state
- CA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1821613803
- Multiple npi flag
- N
- Ccn
- 056021
- Associate id
- 8921427311
- Organization name
- CONTRA LOMA HEALTHCARE, LLC
- Doing business as name
- LONE TREE POST ACUTE
- Incorporation date
- 2020-05-01
- Incorporation state
- CA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- LONE TREE POST ACUTE
- Affiliation entity name
- PACS GROUP
- Affiliation entity id
- 690
- Address line 1
- 4001 LONE TREE WAY
- City
- ANTIOCH
- State
- CA
- Zip code
- 945096232