- Enrollment id
- O20151125000956
- Enrollment state
- GA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1053797340
- Multiple npi flag
- N
- Ccn
- 115580
- Associate id
- 2365742251
- Organization name
- C.R. OF AUTUMN BREEZE, LLC
- Doing business as name
- AUTUMN BREEZE HEALTH AND REHAB
- Incorporation date
- 2015-01-29
- Incorporation state
- GA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 1480 SANDTOWN RD SW
- City
- MARIETTA
- State
- GA
- Zip code
- 300083821