- Enrollment id
- O20170731002952
- Enrollment state
- CO
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1053768192
- Multiple npi flag
- N
- Ccn
- 065251
- Associate id
- 9739450339
- Organization name
- MEADOWBROOK BLVD. OPERATIONS, LLC
- Doing business as name
- PAONIA CARE & REHABILITATION CENTER
- Incorporation date
- 2016-04-17
- Incorporation state
- CO
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- PAONIA CARE AND REHABILITATION CENTER
- Affiliation entity name
- MADISON CREEK PARTNERS
- Affiliation entity id
- 328
- Address line 1
- 1625 MEADOWBROOK BLVD
- City
- PAONIA
- State
- CO
- Zip code
- 814289325