- Enrollment id
- O20190910003907
- Enrollment state
- MD
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1558921759
- Multiple npi flag
- N
- Ccn
- 215203
- Associate id
- 3779812185
- Organization name
- RIVERVIEW OPERATOR, LLC
- Doing business as name
- AUTUMN LAKE HEALTHCARE AT RIVERVIEW
- Incorporation date
- 2019-04-10
- Incorporation state
- NJ
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- AUTUMN LAKE HEALTHCARE AT RIVERVIEW
- Affiliation entity name
- AUTUMN LAKE HEALTHCARE
- Affiliation entity id
- 56
- Address line 1
- 1 EASTERN BLVD
- City
- ESSEX
- State
- MD
- Zip code
- 212217016