- Enrollment id
- O20191212002303
- Enrollment state
- VA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1194361949
- Multiple npi flag
- N
- Ccn
- 495426
- Associate id
- 8022441617
- Organization name
- RBM OPCO OF MARTINSVILLE LLC
- Doing business as name
- MULBERRY CREEK NURSING & REHAB CENTER
- Incorporation date
- 2019-04-29
- Incorporation state
- VA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 300 BLUE RIDGE ST
- City
- MARTINSVILLE
- State
- VA
- Zip code
- 241127258