- Enrollment id
- O20140228000756
- Enrollment state
- MO
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1932522737
- Multiple npi flag
- N
- Ccn
- 265427
- Associate id
- 8820228380
- Organization name
- OAK PARK HEALTHCARE LLC
- Doing business as name
- OAK PARK CARE CENTER
- Incorporation date
- 2013-10-25
- Incorporation state
- MO
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- OAK PARK CARE CENTER
- Affiliation entity name
- MGM HEALTHCARE
- Affiliation entity id
- 348
- Address line 1
- 6637 BERTHOLD AVE
- City
- SAINT LOUIS
- State
- MO
- Zip code
- 631393318