- Enrollment id
- O20040110000201
- Enrollment state
- MN
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1689783987
- Multiple npi flag
- N
- Ccn
- 245344
- Associate id
- 5799685384
- Organization name
- COUNTY OF DODGE
- Doing business as name
- FAIRVIEW CARE CENTER
- Organization type structure
- GOVERNMENT
- Proprietary nonprofit
- N
- Nursing home provider name
- FAIRVIEW CARE CENTER
- Address line 1
- 702 10TH AVE NW
- City
- DODGE CENTER
- State
- MN
- Zip code
- 559279172