- Enrollment id
- O20130522000483
- Enrollment state
- IN
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1255457826
- Multiple npi flag
- N
- Ccn
- 155653
- Associate id
- 0446167415
- Organization name
- MAJOR HOSPITAL
- Doing business as name
- HARBOR HEALTH & REHAB
- Organization type structure
- GOVERNMENT
- Proprietary nonprofit
- N
- Nursing home provider name
- HARBOR HEALTH & REHAB
- Affiliation entity name
- CASA CONSULTING
- Affiliation entity id
- 695
- Address line 1
- 5025 MCCOOK AVE
- City
- EAST CHICAGO
- State
- IN
- Zip code
- 463123759