- Enrollment id
- O20141208000544
- Enrollment state
- IN
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1376662395
- Multiple npi flag
- N
- Ccn
- 155717
- Associate id
- 6002724085
- Organization name
- HENRY COUNTY MEMORIAL HOSPITAL
- Doing business as name
- ALPHA HOME-A WATERS COMMUNITY
- Organization type structure
- OTHER
- Organization other type text
- INDIANA COUNTY HOSPITAL
- Proprietary nonprofit
- N
- Nursing home provider name
- ALPHA HOME - A WATERS COMMUNITY
- Affiliation entity name
- INFINITY HEALTHCARE CONSULTING
- Affiliation entity id
- 763
- Address line 1
- 2640 COLD SPRING RD
- City
- INDIANAPOLIS
- State
- IN
- Zip code
- 462222272