- Enrollment id
- O20240207000515
- Enrollment state
- MT
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1013621473
- Multiple npi flag
- N
- Ccn
- 275049
- Associate id
- 2163865171
- Organization name
- POLSON SNF OPERATIONS LLC
- Doing business as name
- POLSON HEALTH & REHABILITATION CENTER
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- POLSON HEALTH & REHABILITATION CENTER
- Affiliation entity name
- EVERGREEN HEALTHCARE GROUP
- Affiliation entity id
- 846
- Address line 1
- 9 14TH AVE W
- City
- POLSON
- State
- MT
- Zip code
- 598605321