- Enrollment id
- O20211207000125
- Enrollment state
- AR
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1427633353
- Multiple npi flag
- N
- Ccn
- 045359
- Associate id
- 8224428214
- Organization name
- CUMBERLAND STREET OPERATING LLC
- Doing business as name
- THE BLOSSOMS AT CUMBERLAND REHAB & NURSING CENTER
- Incorporation date
- 2020-12-01
- Incorporation state
- AR
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- THE BLOSSOMS AT CUMBERLAND REHAB & NURSING CENTER
- Affiliation entity name
- THE BLOSSOMS REHAB & NURSING CENTER
- Affiliation entity id
- 505
- Address line 1
- 1516 CUMBERLAND STREET
- City
- LITTLE ROCK
- State
- AR
- Zip code
- 722025065