- Enrollment id
- O20180628003019
- Enrollment state
- WA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1811493364
- Multiple npi flag
- N
- Ccn
- 505269
- Associate id
- 3870856354
- Organization name
- 1015 NORTH GARRISON LLC
- Doing business as name
- VANCOUVER SPECIALTY AND REHABILITATIVE CARE
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- VANCOUVER SPECIALTY AND REHAB CARE
- Address line 1
- 1015 N GARRISON RD
- City
- VANCOUVER
- State
- WA
- Zip code
- 986641313