- Enrollment id
- O20120306000478
- Enrollment state
- CA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1831476365
- Multiple npi flag
- N
- Ccn
- 555677
- Associate id
- 0749449049
- Organization name
- HAWTHORNE HEALTHCARE & WELLNESS CENTRE, LP
- Doing business as name
- ROCKPORT HEALTHCARE SERVICES
- Incorporation date
- 2011-11-01
- Incorporation state
- CA
- Organization type structure
- PARTNERSHIP
- Proprietary nonprofit
- P
- Nursing home provider name
- HAWTHORNE HEALTHCARE & WELLNESS CENTRE, LP
- Affiliation entity name
- CORPORATE INTERFACE SERVICES
- Affiliation entity id
- 863
- Address line 1
- 11630 S GREVILLEA AVE
- City
- HAWTHORNE
- State
- CA
- Zip code
- 902502221