- Enrollment id
- O20260218002023
- Enrollment state
- MA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1194601930
- Multiple npi flag
- N
- Ccn
- 225219
- Associate id
- 6901386820
- Organization name
- VANTAGE AT WORCESTER LLC
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- VANTAGE AT WORCESTER LLC
- Address line 1
- 59 ACTON ST
- City
- WORCESTER
- State
- MA
- Zip code
- 016044829