- Enrollment id
- O20060601000216
- Enrollment state
- WA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1538159702
- Multiple npi flag
- N
- Ccn
- 505517
- Associate id
- 4284542663
- Organization name
- STATE OF WASHINGTON, WASHINGTON VETERANS HOMES
- Organization type structure
- OTHER
- Organization other type text
- STATE ENTITY
- Proprietary nonprofit
- N
- Nursing home provider name
- WASHINGTON VETERAN HOME-RETSIL
- Address line 1
- 1141 BEACH DR E
- City
- PORT ORCHARD
- State
- WA
- Zip code
- 983664937