- Enrollment id
- O20200512000587
- Enrollment state
- MT
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1356988349
- Multiple npi flag
- N
- Ccn
- 275134
- Associate id
- 9032540844
- Organization name
- IVY AT DEER LODGE LLC
- Incorporation date
- 2019-05-16
- Incorporation state
- MT
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- IVY AT DEER LODGE
- Affiliation entity name
- IVY HEALTHCARE GROUP
- Affiliation entity id
- 828
- Address line 1
- 1100 TEXAS AVE
- City
- DEER LODGE
- State
- MT
- Zip code
- 597221829