- Enrollment id
- O20090820000417
- Enrollment state
- CA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1972744837
- Multiple npi flag
- N
- Ccn
- 555130
- Associate id
- 0042364382
- Organization name
- MAYWOOD SKILLED NURSING & WELLNESS CENTRE, LLC
- Doing business as name
- MAYWOOD HEALTHCARE AND WELLNESS CENTRE
- Incorporation date
- 2008-07-15
- Incorporation state
- CA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- MAYWOOD SKILLED NURSING & WELLNESS CENTRE
- Affiliation entity name
- PACIFIC HEALTHCARE HOLDINGS
- Affiliation entity id
- 792
- Address line 1
- 6025 PINE AVE
- City
- MAYWOOD
- State
- CA
- Zip code
- 902703108