- Enrollment id
- O20150202001977
- Enrollment state
- WI
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1750376489
- Multiple npi flag
- N
- Ccn
- 525445
- Associate id
- 1153646781
- Organization name
- COLUMBUS OPERATOR LLC
- Doing business as name
- COLUMBUS HEALTH AND REHAB
- Incorporation date
- 2014-06-18
- Incorporation state
- FL
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- COLUMBUS HEALTH AND REHAB
- Affiliation entity name
- MISSION HEALTH COMMUNITIES
- Affiliation entity id
- 354
- Address line 1
- 825 WESTERN AVE
- City
- COLUMBUS
- State
- WI
- Zip code
- 539251675