- Enrollment id
- O20171206000830
- Enrollment state
- NE
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1891225447
- Multiple npi flag
- N
- Ccn
- 285201
- Associate id
- 1355614496
- Organization name
- VSL ST EDWARD LLC
- Doing business as name
- CLOVERLODGE CARE CENTER
- Organization type structure
- LLC
- Proprietary nonprofit
- N
- Nursing home provider name
- CLOVERLODGE CARE CENTER
- Affiliation entity name
- VETTER SENIOR LIVING
- Affiliation entity id
- 547
- Address line 1
- 301 N 13TH ST
- City
- SAINT EDWARD
- State
- NE
- Zip code
- 686604426