- Enrollment id
- O20120117000189
- Enrollment state
- WI
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1295018745
- Multiple npi flag
- N
- Ccn
- 235659
- Associate id
- 3476735200
- Organization name
- CCLA 9 LLC
- Doing business as name
- RIVERVIEW HEALTH & REHAB CENTER
- Incorporation date
- 2009-09-12
- Incorporation state
- MI
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- RIVERVIEW HEALTH & REHAB CENTER
- Address line 1
- 7733 E JEFFERSON AVE
- City
- DETROIT
- State
- MI
- Zip code
- 482143707