- Enrollment id
- O20190222000040
- Enrollment state
- WY
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1053727255
- Multiple npi flag
- N
- Ccn
- 535057
- Associate id
- 9032458856
- Organization name
- VETRAS TORRINGTON SNF LLC
- Doing business as name
- GOSHEN HEALTHCARE COMMUNITY
- Incorporation date
- 2019-01-18
- Incorporation state
- WY
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- GOSHEN HEALTHCARE COMMUNITY
- Address line 1
- 2009 LARAMIE ST
- City
- TORRINGTON
- State
- WY
- Zip code
- 822401533