- Enrollment id
- O20191029002446
- Enrollment state
- KS
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1093364085
- Multiple npi flag
- N
- Ccn
- 175272
- Associate id
- 0840522587
- Organization name
- WAKEFIELD OPERATOR LLC
- Doing business as name
- WAKEFIELD CARE AND REHAB
- Incorporation date
- 2019-07-23
- Incorporation state
- FL
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- WAKEFIELD CARE AND REHAB
- Affiliation entity name
- MISSION HEALTH COMMUNITIES
- Affiliation entity id
- 354
- Address line 1
- 509 GROVE ST
- City
- WAKEFIELD
- State
- KS
- Zip code
- 674879159