- Enrollment id
- O20210521001604
- Enrollment state
- NC
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1477146959
- Multiple npi flag
- N
- Ccn
- 345443
- Associate id
- 4587574355
- Organization name
- LIBERTY HEALTHCARE GROUP LLC
- Doing business as name
- OAK FOREST HEALTH AND REHABILITATION
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- OAK FOREST HEALTH AND REHABILITATION
- Affiliation entity name
- LIBERTY SENIOR LIVING
- Affiliation entity id
- 310
- Address line 1
- 5680 WINDY HILL DR
- City
- WINSTON SALEM
- State
- NC
- Zip code
- 271051425