- Enrollment id
- O20191029001986
- Enrollment state
- KS
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1770132763
- Multiple npi flag
- N
- Ccn
- 175229
- Associate id
- 6103158944
- Organization name
- PARKWAY OPERATOR LLC
- Doing business as name
- PARKWAY CARE AND REHAB
- Incorporation date
- 2019-07-23
- Incorporation state
- FL
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- PARKWAY OPERATOR LLC
- Affiliation entity name
- MISSION HEALTH COMMUNITIES
- Affiliation entity id
- 354
- Address line 1
- 749 BLAKE ST
- City
- EDWARDSVILLE
- State
- KS
- Zip code
- 661111338