- Enrollment id
- O20210412002181
- Enrollment state
- OK
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1184611972
- Multiple npi flag
- N
- Ccn
- 375328
- Associate id
- 2163589359
- Organization name
- TALIHINA MANOR LLC
- Doing business as name
- TALIHINA MANOR
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- TALIHINA MANOR
- Affiliation entity name
- BGM ESTATE
- Affiliation entity id
- 78
- Address line 1
- 301 EMMERT ST.
- City
- TALIHINA
- State
- OK
- Zip code
- 74571