- Enrollment id
- O20210517000103
- Enrollment state
- FL
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1063097921
- Multiple npi flag
- N
- Ccn
- 105826
- Associate id
- 8820407216
- Organization name
- THE PAVILION AT JACKSONVILLE FOR NURSING AND REHABILITATION LLC
- Doing business as name
- THE PAVILION AT JACKSONVILLE
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- PAVILION AT JACKSONVILLE, THE
- Affiliation entity name
- THE PAVILION GROUP
- Affiliation entity id
- 514
- Address line 1
- 1771 EDGEWOOD AVE W
- City
- JACKSONVILLE
- State
- FL
- Zip code
- 322083278