- Enrollment id
- O20210115001463
- Enrollment state
- OH
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1114522919
- Multiple npi flag
- N
- Ccn
- 365101
- Associate id
- 5092128850
- Organization name
- SPRING CREEK NURSING AND REHABILITATION CENTER LLC
- Incorporation date
- 2020-10-15
- Incorporation state
- OH
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- SPRING CREEK NURSING AND REHABILITATION CENTER LLC
- Address line 1
- 401 N BROADWAY ST
- City
- GREEN SPRINGS
- State
- OH
- Zip code
- 448369653