- Enrollment id
- O20240326001944
- Enrollment state
- TX
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1093232084
- Multiple npi flag
- N
- Ccn
- 676304
- Associate id
- 3870712482
- Organization name
- WINNIE-STOWELL HOSPITAL DISTRICT
- Doing business as name
- CREEKSIDE VILLAGE
- Organization type structure
- GOVERNMENT
- Proprietary nonprofit
- N
- Nursing home provider name
- CREEKSIDE VILLAGE
- Affiliation entity name
- GULF COAST LTC PARTNERS
- Affiliation entity id
- 243
- Address line 1
- 914 BRAZOSPORT BLVD N
- City
- RICHWOOD
- State
- TX
- Zip code
- 775313720