- Enrollment id
- O20120806000380
- Enrollment state
- FL
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1215926910
- Multiple npi flag
- N
- Ccn
- 105432
- Associate id
- 7113173212
- Organization name
- STACEY HEALTH CARE CENTERS INC RIVERSIDE CARE CENTER
- Incorporation date
- 1982-07-15
- Incorporation state
- FL
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Nursing home provider name
- RIVERSIDE CARE CENTER
- Address line 1
- 899 NW 4TH STREET
- City
- MIAMI
- State
- FL
- Zip code
- 331281309