- Enrollment id
- O20070813000615
- Enrollment state
- WV
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1346449451
- Multiple npi flag
- N
- Ccn
- 515156
- Associate id
- 8123119609
- Organization name
- BLUE RIDGE NURSING LLC
- Doing business as name
- WILLOW TREE HEALTHCARE CENTER
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- WILLOW TREE HEALTHCARE CENTER
- Affiliation entity name
- COMMUNICARE HEALTH
- Affiliation entity id
- 153
- Address line 1
- 1263 S GEORGE ST
- City
- CHARLES TOWN
- State
- WV
- Zip code
- 254144384