- Enrollment id
- O20200121000751
- Enrollment state
- AR
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1366089427
- Multiple npi flag
- N
- Ccn
- 045195
- Associate id
- 7517392558
- Organization name
- WEST MEMPHIS WELLNESS LLC
- Doing business as name
- THE SPRINGS BROADWAY
- Incorporation date
- 2019-11-21
- Incorporation state
- AR
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- THE SPRINGS BROADWAY
- Affiliation entity name
- THE SPRINGS ARKANSAS
- Affiliation entity id
- 516
- Address line 1
- 800 W BROADWAY ST
- City
- WEST MEMPHIS
- State
- AR
- Zip code
- 723012912