- Enrollment id
- O20040803000501
- Enrollment state
- NJ
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1861491540
- Multiple npi flag
- N
- Ccn
- 315477
- Associate id
- 1658342712
- Organization name
- 493 BLACK OAK RIDGE ROAD, LLC
- Doing business as name
- CARE ONE AT WAYNE
- Incorporation date
- 2004-03-18
- Incorporation state
- NJ
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- CAREONE AT WAYNE
- Affiliation entity name
- CAREONE
- Affiliation entity id
- 109
- Address line 1
- 493 BLACK OAK RIDGE RD
- Address line 2
- CARE ONE AT WAYNE
- City
- WAYNE
- State
- NJ
- Zip code
- 074706501