- Enrollment id
- O20220805001778
- Enrollment state
- AL
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1417690157
- Multiple npi flag
- N
- Ccn
- 015396
- Associate id
- 1153703228
- Organization name
- DAC OF GREENSBORO LLC
- Doing business as name
- DIVERSICARE OF GREENSBORO
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- DIVERSICARE OF GREENSBORO
- Affiliation entity name
- DIVERSICARE HEALTHCARE
- Affiliation entity id
- 185
- Address line 1
- 616 ARMORY ST
- City
- GREENSBORO
- State
- AL
- Zip code
- 367442110