- Enrollment id
- O20200318001137
- Enrollment state
- CO
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1700416849
- Multiple npi flag
- N
- Ccn
- 065302
- Associate id
- 9739517129
- Organization name
- RED OAK REHABILITATION AND CARE COMMUNITY LLC
- Doing business as name
- RED OAK REHABILITATION AND CARE COMMUNITY LLC
- Incorporation date
- 2020-01-14
- Incorporation state
- CO
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- REGENT PARK CARE CENTER
- Affiliation entity name
- VIVAGE SENIOR LIVING
- Affiliation entity id
- 552
- Address line 1
- 816 SOUTH INTEROCEAN AVENUE
- City
- HOLYOKE
- State
- CO
- Zip code
- 807342120