- Enrollment id
- O20120306000256
- Enrollment state
- WI
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1801006978
- Multiple npi flag
- N
- Ccn
- 525431
- Associate id
- 6103085477
- Organization name
- MIDWAY MANOR CORP
- Doing business as name
- CLAIRIDGE HOUSE
- Incorporation date
- 1973-05-02
- Incorporation state
- WI
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Nursing home provider name
- CLAIRIDGE HOUSE
- Affiliation entity name
- REAL PROPERTY HEALTH FACILITIES
- Affiliation entity id
- 605
- Address line 1
- 1519 60TH ST
- City
- KENOSHA
- State
- WI
- Zip code
- 531403954