- Enrollment id
- O20240606000577
- Enrollment state
- UT
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1962252213
- Multiple npi flag
- N
- Ccn
- 465187
- Associate id
- 0941742985
- Organization name
- HOLBROOK HEALTHCARE LLC
- Doing business as name
- SOUTH DAVIS SPECIALTY CARE
- Incorporation date
- 2024-03-22
- Incorporation state
- NV
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- SOUTH DAVIS SPECIALTY CARE
- Affiliation entity name
- THE ENSIGN GROUP
- Affiliation entity id
- 507
- Address line 1
- 481 S 400 E
- City
- BOUNTIFUL
- State
- UT
- Zip code
- 840104933