- Enrollment id
- O20190115002695
- Enrollment state
- OH
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1922599729
- Multiple npi flag
- N
- Ccn
- 365483
- Associate id
- 3072859826
- Organization name
- MIAMI COV SNF INC
- Doing business as name
- STILLWATER SKILLED NURSING AND REHABILITATION
- Incorporation date
- 2018-05-23
- Incorporation state
- OH
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Nursing home provider name
- STILLWATER SKILLED NURSING AND REHABILITATION
- Affiliation entity name
- MICHAEL SLYK
- Affiliation entity id
- 789
- Address line 1
- 75 MOTE DR
- City
- COVINGTON
- State
- OH
- Zip code
- 453181245