- Enrollment id
- O20211102001919
- Enrollment state
- CT
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1386210755
- Multiple npi flag
- N
- Ccn
- 075200
- Associate id
- 2365830809
- Organization name
- SOUTHPORT CENTER FOR NURSING & REHABILITATION LLC
- Doing business as name
- SOUTHPORT CENTER FOR NURSING AND REHABILITATION
- Incorporation date
- 2021-02-23
- Incorporation state
- CT
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- SOUTHPORT CENTER FOR NURSING & REHABILITATION LLC
- Affiliation entity name
- ESSENTIAL HEALTHCARE
- Affiliation entity id
- 212
- Address line 1
- 930 MILL HILL TER
- City
- SOUTHPORT
- State
- CT
- Zip code
- 068901265