- Enrollment id
- O20190205001357
- Enrollment state
- OH
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1811488612
- Multiple npi flag
- N
- Ccn
- 365297
- Associate id
- 2769720481
- Organization name
- SIDNEY SNF INC
- Doing business as name
- SHELBY SKILLED NURSING AND REHABILITATION
- Incorporation date
- 2018-05-23
- Incorporation state
- OH
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Nursing home provider name
- SHELBY SKILLED NURSING AND REHABILITATION
- Affiliation entity name
- MICHAEL SLYK
- Affiliation entity id
- 789
- Address line 1
- 705 FULTON ST
- City
- SIDNEY
- State
- OH
- Zip code
- 453653203