- Enrollment id
- O20150224001596
- Enrollment state
- TX
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1144662990
- Multiple npi flag
- N
- Ccn
- 676044
- Associate id
- 8527963776
- Organization name
- GONZALES HEALTHCARE SYSTEMS
- Doing business as name
- AVIR AT MAGNOLIA
- Organization type structure
- GOVERNMENT
- Proprietary nonprofit
- N
- Nursing home provider name
- AVIR AT MAGNOLIA
- Affiliation entity name
- AVIR HEALTH GROUP
- Affiliation entity id
- 719
- Address line 1
- 1105 N MAGNOLIA AVE
- City
- LULING
- State
- TX
- Zip code
- 786481604