- Enrollment id
- O20181115001727
- Enrollment state
- ID
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1306322953
- Multiple npi flag
- N
- Ccn
- 135134
- Associate id
- 3870847551
- Organization name
- BENNETT HEALTHCARE LLC
- Doing business as name
- BENNETT HILLS REHABILITATION AND CARE CENTER
- Incorporation date
- 2018-05-18
- Incorporation state
- NV
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- BENNETT HILLS REHABILITATION AND CARE CENTER
- Affiliation entity name
- THE ENSIGN GROUP
- Affiliation entity id
- 507
- Address line 1
- 1220 MONTANA ST
- City
- GOODING
- State
- ID
- Zip code
- 833301856