- Enrollment id
- O20180613000532
- Enrollment state
- WI
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1700312436
- Multiple npi flag
- N
- Ccn
- 525281
- Associate id
- 7416202585
- Organization name
- THE BAY AT WATERS EDGE HEALTH AND REHABILITATION LLC
- Doing business as name
- WATERS EDGE HEALTH AND REHABILITATION CENTER
- Incorporation date
- 2018-02-01
- Incorporation state
- WI
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- WATERS EDGE HEALTH AND REHABILITATION CENTER
- Affiliation entity name
- CHAMPION CARE
- Affiliation entity id
- 134
- Address line 1
- 3415 SHERIDAN RD
- City
- KENOSHA
- State
- WI
- Zip code
- 531401924