- Enrollment id
- O20230912003763
- Enrollment state
- CA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1902505746
- Multiple npi flag
- N
- Ccn
- 555104
- Associate id
- 7618331406
- Organization name
- LIME RIDGE HEALTHCARE LLC
- Doing business as name
- CONCORD POST ACUTE
- Incorporation date
- 2020-05-01
- Incorporation state
- CA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- CONCORD POST ACUTE
- Affiliation entity name
- PACS GROUP
- Affiliation entity id
- 690
- Address line 1
- 1050 SAN MIGUEL RD
- City
- CONCORD
- State
- CA
- Zip code
- 945182094