- Enrollment id
- O20100212000691
- Enrollment state
- MO
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1558362087
- Multiple npi flag
- N
- Ccn
- 265634
- Associate id
- 5698819746
- Organization name
- LACOBA HOMES INC
- Doing business as name
- LACOBA HOMES INC.
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- N
- Nursing home provider name
- LACOBA HOMES INC
- Address line 1
- 850 HIGHWAY 60
- City
- MONETT
- State
- MO
- Zip code
- 657089376