- Enrollment id
- O20211105000651
- Enrollment state
- GA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1174290100
- Multiple npi flag
- N
- Ccn
- 115544
- Associate id
- 3870982200
- Organization name
- GA OPCO LLC
- Doing business as name
- PINE VIEW NURSING AND REHAB CENTER
- Incorporation date
- 2021-05-12
- Incorporation state
- NJ
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- PINE VIEW NURSING AND REHAB
- Affiliation entity name
- ELIYAHU MIRLIS
- Affiliation entity id
- 710
- Address line 1
- 411 PINE ST
- City
- SYLVANIA
- State
- GA
- Zip code
- 304672035