- Enrollment id
- O20150723006881
- Enrollment state
- OH
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1427437698
- Multiple npi flag
- N
- Ccn
- 365129
- Associate id
- 1153634969
- Organization name
- 17322 EUCLID AVENUE COMPANY LLC
- Doing business as name
- EASTBROOK HEALTHCARE CENTER
- Incorporation date
- 2015-04-09
- Incorporation state
- OH
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- EASTBROOK HEALTHCARE CENTER
- Affiliation entity name
- GARDEN SPRINGS HEALTHCARE
- Affiliation entity id
- 805
- Address line 1
- 17322 EUCLID AVE
- City
- CLEVELAND
- State
- OH
- Zip code
- 441121210