- Enrollment id
- O20220317002809
- Enrollment state
- OH
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1649935669
- Multiple npi flag
- N
- Ccn
- 365617
- Associate id
- 9234524869
- Organization name
- BUCKEYE FOREST AT WATERVILLE
- Doing business as name
- AYDEN HEALTHCARE OF WATERVILLE
- Incorporation date
- 2021-08-17
- Incorporation state
- NY
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- AYDEN HEALTHCARE OF WATERVILLE
- Affiliation entity name
- AYDEN HEALTHCARE
- Affiliation entity id
- 63
- Address line 1
- 8885 BROWNING DR
- City
- WATERVILLE
- State
- OH
- Zip code
- 435669701