- Enrollment id
- O20230324002624
- Enrollment state
- AR
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1043949522
- Multiple npi flag
- N
- Ccn
- 045190
- Associate id
- 4981078326
- Organization name
- CROSSETT HEALTHCARE LLC
- Doing business as name
- NIGHTINGALE AT CROSSETT
- Incorporation date
- 2021-07-12
- Incorporation state
- AR
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- NIGHTINGALE AT CROSSETT
- Affiliation entity name
- NIGHTINGALE
- Affiliation entity id
- 815
- Address line 1
- 1101 WATERWELL RD
- City
- CROSSETT
- State
- AR
- Zip code
- 716354152