- Enrollment id
- O20131203001065
- Enrollment state
- VT
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1295172369
- Multiple npi flag
- N
- Ccn
- 475033
- Associate id
- 7517193113
- Organization name
- CM HEALTHCARE LLC
- Doing business as name
- CRESCENT MANOR REHABILITATION
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- CRESCENT MANOR CARE CTRS
- Address line 1
- 312 CRESCENT BLVD
- City
- BENNINGTON
- State
- VT
- Zip code
- 052012419