- Enrollment id
- O20260421002632
- Enrollment state
- TN
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1235008418
- Multiple npi flag
- N
- Ccn
- 445285
- Associate id
- 4587130091
- Organization name
- REELFOOT HEALTHCARE AND REHAB LLC
- Doing business as name
- REELFOOT MANOR HEALTH AND REHAB
- Organization type structure
- LLC
- Proprietary nonprofit
- D
- Nursing home provider name
- REELFOOT MANOR HEALTH AND REHAB
- Address line 1
- 1034 REELFOOT ST
- City
- TIPTONVILLE
- State
- TN
- Zip code
- 380791607