- Enrollment id
- O20031125000329
- Enrollment state
- FL
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1366439952
- Multiple npi flag
- N
- Ccn
- 105730
- Associate id
- 2668385352
- Organization name
- SPRING LAKE NC, LLC
- Doing business as name
- SPRING LAKE REHABILITATION CENTER
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- SPRING LAKE REHABILITATION CENTER
- Affiliation entity name
- CLEAR CHOICE HEALTHCARE
- Affiliation entity id
- 149
- Address line 1
- 1540 6TH ST NW
- City
- WINTER HAVEN
- State
- FL
- Zip code
- 338812368