- Enrollment id
- O20230406000769
- Enrollment state
- NJ
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1538883707
- Multiple npi flag
- N
- Ccn
- 315501
- Associate id
- 0547635435
- Organization name
- COMPLETE CARE AT WALL LLC
- Doing business as name
- COMPLETE CARE AT WALL LLC
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- COMPLETE CARE AT WALL LLC
- Affiliation entity name
- COMPLETE CARE
- Affiliation entity id
- 157
- Address line 1
- 1725 MERIDIAN TRL
- City
- WALL TOWNSHIP
- State
- NJ
- Zip code
- 077193869