- Enrollment id
- O20190904001020
- Enrollment state
- MD
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1043870256
- Multiple npi flag
- N
- Ccn
- 215338
- Associate id
- 6204165020
- Organization name
- OAKVIEW OPERATOR, LLC
- Doing business as name
- AUTUMN LAKE HEALTHCARE AT OAKVIEW
- Incorporation date
- 2019-04-10
- Incorporation state
- NJ
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- AUTUMN LAKE HEALTHCARE AT OAKVIEW
- Affiliation entity name
- AUTUMN LAKE HEALTHCARE
- Affiliation entity id
- 56
- Address line 1
- 2700 BARKER ST
- City
- SILVER SPRING
- State
- MD
- Zip code
- 209101001