- Enrollment id
- O20031110000190
- Enrollment state
- FL
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1376530956
- Multiple npi flag
- N
- Ccn
- 105635
- Associate id
- 3274446984
- Organization name
- MELBOURNE TERRACE RCC, LLC
- Doing business as name
- MELBOURNE TERRACE REHABILITATION CENTER
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- MELBOURNE TERRACE REHABILITATION CENTER
- Affiliation entity name
- CLEAR CHOICE HEALTHCARE
- Affiliation entity id
- 149
- Address line 1
- 251 FLORIDA AVE
- City
- MELBOURNE
- State
- FL
- Zip code
- 329018303