- Enrollment id
- O20100225000783
- Enrollment state
- OH
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1134103617
- Multiple npi flag
- N
- Ccn
- 365794
- Associate id
- 6507900776
- Organization name
- PATASKALA LAND CORPORATION
- Doing business as name
- PATASKALA OAKS CARE CENTER
- Incorporation date
- 1987-07-22
- Incorporation state
- OH
- Organization type structure
- OTHER
- Organization other type text
- S-CORPORATION
- Proprietary nonprofit
- P
- Nursing home provider name
- PATASKALA OAKS CARE CENTER
- Affiliation entity name
- NURSING CARE MANAGEMENT OF AMERICA
- Affiliation entity id
- 379
- Address line 1
- 144E BROAD ST
- City
- PATASKALA
- State
- OH
- Zip code
- 430627536