- Enrollment id
- O20141211001199
- Enrollment state
- MO
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1144626078
- Multiple npi flag
- N
- Ccn
- 265130
- Associate id
- 9638491186
- Organization name
- BBW MANAGEMENT GROUP LLC
- Doing business as name
- BIG BEND WOODS HEALTHCARE CENTER
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- BIG BEND WOODS HEALTHCARE CENTER
- Address line 1
- 110 HIGHLAND AVENUE
- Address line 2
- BIG BEND WOODS HEALTHCARE CENTER
- City
- VALLEY PARK
- State
- MO
- Zip code
- 630881422