- Enrollment id
- O20230928000040
- Enrollment state
- NE
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1124709852
- Multiple npi flag
- N
- Ccn
- 285143
- Associate id
- 4082068895
- Organization name
- MULBERRY AT WAVERLY LLC
- Doing business as name
- THE MULBERRY AT WAVERLY
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 11041 N 137TH ST
- City
- WAVERLY
- State
- NE
- Zip code
- 684621022