- Enrollment id
- O20070827000214
- Enrollment state
- MS
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1154513414
- Multiple npi flag
- N
- Ccn
- 255192
- Associate id
- 3870685563
- Organization name
- CLAIBORNE COUNTY SENIOR CARE LLC
- Incorporation date
- 2007-08-01
- Incorporation state
- MS
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- CLAIBORNE COUNTY SENIOR CARE
- Affiliation entity name
- TREND CONSULTANTS
- Affiliation entity id
- 522
- Address line 1
- 2124 OLD HIGHWAY 61 S
- City
- PORT GIBSON
- State
- MS
- Zip code
- 391502589