- Enrollment id
- O20150226000158
- Enrollment state
- CO
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1790123669
- Multiple npi flag
- N
- Ccn
- 065284
- Associate id
- 8921324559
- Organization name
- MADISON SENIOR LIVING MANAGEMENT LLC
- Doing business as name
- GRACE MANOR CARE CENTER
- Incorporation date
- 2012-06-12
- Incorporation state
- DE
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- GRACE MANOR CARE CENTER
- Affiliation entity name
- FRONTLINE MANAGEMENT
- Affiliation entity id
- 230
- Address line 1
- 465 FIFTH STREET
- City
- BURLINGTON
- State
- CO
- Zip code
- 808071932