- Enrollment id
- O20220818000247
- Enrollment state
- TX
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1063144996
- Multiple npi flag
- N
- Ccn
- 675002
- Associate id
- 2466369061
- Organization name
- MAVERICK COUNTY HOSPITAL DISTRICT
- Doing business as name
- SAN ANTONIO WEST NURSING AND REHABILITATION
- Organization type structure
- GOVERNMENT
- Proprietary nonprofit
- N
- Nursing home provider name
- SAN ANTONIO WEST NURSING AND REHABILITATION
- Address line 1
- 636 CUPPLES RD
- City
- SAN ANTONIO
- State
- TX
- Zip code
- 782374328