- Enrollment id
- O20170413001561
- Enrollment state
- ID
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1760925572
- Multiple npi flag
- N
- Ccn
- 135048
- Associate id
- 5294011862
- Organization name
- CLEARWATER OF CASCADIA
- Doing business as name
- CLEARWATER HEALTH & REHABILITATION OF CASCADIA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- CLEARWATER HEALTH & REHABILITATION OF CASCADIA
- Affiliation entity name
- CASCADIA HEALTHCARE
- Affiliation entity id
- 118
- Address line 1
- 1204 SHRIVER RD
- City
- OROFINO
- State
- ID
- Zip code
- 835449033