- Enrollment id
- O20151023000912
- Enrollment state
- CA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1831573856
- Multiple npi flag
- N
- Ccn
- 555574
- Associate id
- 3779892260
- Organization name
- CUCUMBER HOLDINGS LLC
- Doing business as name
- STONEY POINT HEALTHCARE CENTER
- Incorporation date
- 2015-06-30
- Incorporation state
- DE
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- STONEY POINT HEALTHCARE CENTER
- Affiliation entity name
- PACS GROUP
- Affiliation entity id
- 690
- Address line 1
- 21820 CRAGGY VIEW ST
- City
- CHATSWORTH
- State
- CA
- Zip code
- 913112909