- Enrollment id
- O20141111000545
- Enrollment state
- PA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1134537426
- Multiple npi flag
- N
- Ccn
- 395338
- Associate id
- 7113149972
- Organization name
- 2990 HOLME OPERATING LLC
- Doing business as name
- IMMACULATE MARY CENTER FOR REHABILITATION & HEALTHCARE
- Incorporation date
- 2014-05-07
- Incorporation state
- PA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- IMMACULATEMARYCENTER FOR REHABILITATION&HEALTHCARE
- Affiliation entity name
- CENTER MANAGEMENT GROUP
- Affiliation entity id
- 619
- Address line 1
- 2990 HOLME AVENUE
- Address line 2
- IMMACULATE MARY CENTER FOR REHABILITATION & HEALTH
- City
- PHILADELPHIA
- State
- PA
- Zip code
- 161361830