- Enrollment id
- O20200203002009
- Enrollment state
- CO
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1669027033
- Multiple npi flag
- N
- Ccn
- 067590
- Associate id
- 4587090972
- Organization name
- BEACON SKILLED CARE LLC
- Incorporation date
- 2019-02-13
- Incorporation state
- CO
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 1450 S HAVANA ST
- Address line 2
- STE 707
- City
- AURORA
- State
- CO
- Zip code
- 800124034