- Enrollment id
- O20200829000029
- Enrollment state
- OH
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1992321392
- Multiple npi flag
- N
- Ccn
- 365717
- Associate id
- 1153748686
- Organization name
- DUBLIN CONVALARIUM OPERATING COMPANY, LLC
- Doing business as name
- THE CONVALARIUM OF DUBLIN
- Incorporation date
- 2020-04-27
- Incorporation state
- OH
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- THE CONVALARIUM OF DUBLIN
- Affiliation entity name
- LIONSTONE CARE
- Affiliation entity id
- 611
- Address line 1
- 6430 POST RD
- City
- DUBLIN
- State
- OH
- Zip code
- 430161226