- Enrollment id
- O20100618000712
- Enrollment state
- OH
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1396883591
- Multiple npi flag
- N
- Ccn
- 365883
- Associate id
- 6709808116
- Organization name
- ST AUGUSTINE MANOR
- Incorporation date
- 1969-10-24
- Incorporation state
- OH
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- N
- Nursing home provider name
- ST AUGUSTINE MANOR
- Address line 1
- 7801 DETROIT AVE
- City
- CLEVELAND
- State
- OH
- Zip code
- 441022813