| Name | Value |
|---|---|
| PROVIDER TYPE | Nursing & Custodial Care Facilities |
| CLASSIFICATION | Christian Science Facility |
| DEFINITION | Inactive, use 282J00000X |
| STATUS | Inactive |
| DATE INACTIVATED | 2009-10-01 00:00:00 |
| X12 CODE | 317400000X |
| INDIVIDUAL/NON | NON-INDIVIDUAL |
| MASTER ENTRY FOR VUID | YES |
| VUID | 5252783 |
| EFFECTIVE DATE/TIME |
|