- Enrollment id
- O20150224000888
- Enrollment state
- TX
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1104233592
- Multiple npi flag
- N
- Ccn
- 675139
- Associate id
- 7719886282
- Organization name
- CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY
- Doing business as name
- WINDSOR HEALTHCARE RESIDENCE
- Organization type structure
- OTHER
- Organization other type text
- HOSPITAL AUTHORITY
- Proprietary nonprofit
- N
- Nursing home provider name
- WINDSOR HEALTHCARE RESIDENCE
- Affiliation entity name
- CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY
- Affiliation entity id
- 163
- Address line 1
- 1025 W YEAGUA ST
- Address line 2
- WINDSOR HEALTHCARE RESIDENCE
- City
- GROESBECK
- State
- TX
- Zip code
- 766423529