- Enrollment id
- O20170922001468
- Enrollment state
- CA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1982127338
- Multiple npi flag
- N
- Ccn
- 555254
- Associate id
- 7214201649
- Organization name
- OAKLANDIDENCE OPCO, LLC
- Doing business as name
- MEDICAL HILL HEALTHCARE CENTER
- Incorporation date
- 2017-07-17
- Incorporation state
- CA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- MEDICAL HILL HEALTHCARE CENTER
- Affiliation entity name
- PACS GROUP
- Affiliation entity id
- 690
- Address line 1
- 475 29TH ST
- City
- OAKLAND
- State
- CA
- Zip code
- 946093510