- Enrollment id
- O20231229003039
- Enrollment state
- FL
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1114703980
- Multiple npi flag
- N
- Ccn
- 105296
- Associate id
- 4385094572
- Organization name
- DANIA BEACH OPCO LLC
- Doing business as name
- WESTLAKE NURSING AND REHAB CENTER
- Incorporation date
- 2023-07-19
- Incorporation state
- DE
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- WESTLAKE NURSING AND REHAB CENTER
- Affiliation entity name
- ELIYAHU MIRLIS
- Affiliation entity id
- 710
- Address line 1
- 440 PHIPPEN WAITERS RD
- City
- DANIA BEACH
- State
- FL
- Zip code
- 330044931