- Enrollment id
- O20170526001222
- Enrollment state
- WI
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1134671308
- Multiple npi flag
- N
- Ccn
- 525477
- Associate id
- 2466729256
- Organization name
- NSH SOUTH SHORE LLC
- Doing business as name
- ST FRANCIS HEALTH SERVICES
- Incorporation date
- 2016-09-24
- Incorporation state
- WI
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- ST FRANCIS HEALTH SERVICES
- Affiliation entity name
- NORTH SHORE HEALTHCARE
- Affiliation entity id
- 377
- Address line 1
- 1915 E TRIPOLI AVE
- City
- ST FRANCIS
- State
- WI
- Zip code
- 532354142