- Enrollment id
- O20140421001727
- Enrollment state
- OH
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1346665700
- Multiple npi flag
- N
- Ccn
- 366145
- Associate id
- 4486886777
- Organization name
- LAKERIDGE ACRES NURSING & REHABILITATION CENTER LLC
- Doing business as name
- CARECORE AT LAKERIDGE
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- LAKERIDGE VILLA HEALTH CARE CENTER
- Affiliation entity name
- CARECORE HEALTH
- Affiliation entity id
- 108
- Address line 1
- 7220 PIPPIN RD
- City
- CINCINNATI
- State
- OH
- Zip code
- 452394607