- Enrollment id
- O20230304000086
- Enrollment state
- MD
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1114632098
- Multiple npi flag
- N
- Ccn
- 215145
- Associate id
- 4981077310
- Organization name
- COMPLETE CARE AT HYATTSVILLE LLC
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- COMPLETE CARE AT HYATTSVILLE
- Affiliation entity name
- COMPLETE CARE
- Affiliation entity id
- 157
- Address line 1
- 4922 LASALLE ROAD
- City
- HYATTSVILLE
- State
- MD
- Zip code
- 207823302