- Enrollment id
- O20180222002581
- Enrollment state
- WI
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1033620596
- Multiple npi flag
- N
- Ccn
- 525622
- Associate id
- 4981965514
- Organization name
- NSH SOLDIERS GROVE LLC
- Doing business as name
- SOLDIERS GROVE HEALTH SERVICES
- Incorporation date
- 2017-10-05
- Incorporation state
- WI
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- SOLDIERS GROVE HEALTH SERVICES
- Affiliation entity name
- NORTH SHORE HEALTHCARE
- Affiliation entity id
- 377
- Address line 1
- 101 SUNSHINE BLVD
- City
- SOLDIERS GROVE
- State
- WI
- Zip code
- 546557106