- Enrollment id
- O20250624002200
- Enrollment state
- NC
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1427866474
- Multiple npi flag
- N
- Ccn
- 345464
- Associate id
- 3971015108
- Organization name
- 518 OLD US HIGHWAY 221 OPCO LLC
- Doing business as name
- OAK GROVE HEALTHCARE
- Organization type structure
- LLC
- Proprietary nonprofit
- D
- Nursing home provider name
- OAK GROVE HEALTHCARE
- Affiliation entity name
- AVARDIS HEALTH
- Affiliation entity id
- 843
- Address line 1
- 518 OLD US 221 HWY N
- City
- RUTHERFORDTON
- State
- NC
- Zip code
- 281398670