- Enrollment id
- O20190321002728
- Enrollment state
- MD
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1003386780
- Multiple npi flag
- N
- Ccn
- 215330
- Associate id
- 3274872452
- Organization name
- POST-ACUTE CARE CENTER OPCO LLC
- Doing business as name
- POST-ACUTE CARE CENTER
- Incorporation date
- 2018-11-13
- Incorporation state
- DE
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- AUTUMN LAKE HEALTHCARE POST-ACUTE CARE CENTER
- Affiliation entity name
- AUTUMN LAKE HEALTHCARE
- Affiliation entity id
- 56
- Address line 1
- 5009 FRANKFORD AVE
- City
- BALTIMORE
- State
- MD
- Zip code
- 212065353