- Enrollment id
- O20111221000164
- Enrollment state
- CT
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1902965007
- Multiple npi flag
- N
- Ccn
- 075232
- Associate id
- 3971779059
- Organization name
- Z INCORPORATED
- Doing business as name
- COBALT LODGE HEALTH CARE AND REHABILITATION CENTER
- Incorporation date
- 1968-05-16
- Incorporation state
- CT
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Nursing home provider name
- COBALT LODGE HEALTH CARE AND REHABILITATION CENTER
- Address line 1
- 29 MIDDLE HADDAM ROAD
- City
- COBALT
- State
- CT
- Zip code
- 064140246