- Enrollment id
- O20110824000428
- Enrollment state
- CA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1932496767
- Multiple npi flag
- N
- Ccn
- 055932
- Associate id
- 3274703590
- Organization name
- FOUR SEASONS HEALTHCARE & WELLNESS CENTER, LP
- Doing business as name
- ROCKPORT HEALTHCARE SERVICES
- Incorporation date
- 2011-06-07
- Incorporation state
- CA
- Organization type structure
- PARTNERSHIP
- Proprietary nonprofit
- P
- Nursing home provider name
- FOUR SEASONS HEALTHCARE & WELLNESS CENTER, LP
- Affiliation entity name
- CORPORATE INTERFACE SERVICES
- Affiliation entity id
- 863
- Address line 1
- 5335 LAUREL CANYON BLVD
- City
- NORTH HOLLYWOOD
- State
- CA
- Zip code
- 916072711