- Enrollment id
- O20190426001217
- Enrollment state
- LA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1184185654
- Multiple npi flag
- N
- Ccn
- 195615
- Associate id
- 6608118401
- Organization name
- PMG OPCO-WASHINGTON LLC
- Doing business as name
- BOOKER T. WASHINGTON SKILLED NURSING AND REHABILITATION
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- BOOKER T. WASHINGTON SKILLED NURSING AND REHABILITATION
- Affiliation entity name
- PRIORITY MANAGEMENT
- Affiliation entity id
- 425
- Address line 1
- 7605 LINE AVE
- City
- SHREVEPORT
- State
- LA
- Zip code
- 711065162