- Enrollment id
- O20180320000721
- Enrollment state
- MT
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1053827824
- Multiple npi flag
- N
- Ccn
- 275060
- Associate id
- 6406118025
- Organization name
- COPPER RIDGE NURSING AND REHAB CENTER LLC
- Doing business as name
- COPPER RIDGE NURSING AND REHAB CENTER
- Incorporation date
- 2017-12-04
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- COPPER RIDGE HEALTH AND REHABILITATION CENTER
- Affiliation entity name
- EDURO HEALTHCARE
- Affiliation entity id
- 193
- Address line 1
- 3251 NETTIE ST
- City
- BUTTE
- State
- MT
- Zip code
- 597016531