- Enrollment id
- O20230622002205
- Enrollment state
- ID
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1811614332
- Multiple npi flag
- N
- Ccn
- 135067
- Associate id
- 6608234638
- Organization name
- MOSCOW NORTH OF CASCADIA LLC
- Doing business as name
- PARADISE CREEK HEALTH AND REHABILITATION OF CASCADIA
- Incorporation date
- 2022-10-21
- Incorporation state
- DE
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- PARADISE CREEK HEALTH AND REHAB OF CASCADIA
- Affiliation entity name
- CASCADIA HEALTHCARE
- Affiliation entity id
- 118
- Address line 1
- 640 N EISENHOWER ST
- City
- MOSCOW
- State
- ID
- Zip code
- 838439588