- Enrollment id
- O20190102000365
- Enrollment state
- TN
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1114400975
- Multiple npi flag
- N
- Ccn
- 445495
- Associate id
- 1254685878
- Organization name
- COLLIERVILLE NURSING AND REHABILITATION LLC
- Doing business as name
- COLLIERVILLE NURSING AND REHABILITATION
- Incorporation date
- 2018-07-30
- Incorporation state
- TN
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- COLLIERVILLE NURSING AND REHABILITATION, LLC
- Affiliation entity name
- SIMCHA HYMAN & NAFTALI ZANZIPER
- Affiliation entity id
- 580
- Address line 1
- 490 W POPLAR AVE
- City
- COLLIERVILLE
- State
- TN
- Zip code
- 380172538