- Enrollment id
- O20240924000277
- Enrollment state
- MO
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1427897255
- Multiple npi flag
- N
- Ccn
- 265672
- Associate id
- 8729529334
- Organization name
- SAGE NURSING & REHAB LLC
- Doing business as name
- MAGNOLIA WELLNESS CENTER
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- MAGNOLIA WELLNESS CENTER
- Affiliation entity name
- OPCO SKILLED MANAGEMENT
- Affiliation entity id
- 773
- Address line 1
- 3421 GASCONADE ST
- City
- SAINT LOUIS
- State
- MO
- Zip code
- 631184201