- Enrollment id
- O20130718000465
- Enrollment state
- GA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1457365017
- Multiple npi flag
- N
- Ccn
- 115457
- Associate id
- 8729229646
- Organization name
- PINE LEAF INVESTMENT INC
- Doing business as name
- MADISON HEALTH AND REHAB
- Incorporation date
- 2000-10-01
- Incorporation state
- GA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Nursing home provider name
- MADISON HEALTH AND REHAB
- Address line 1
- 2036 S MAIN ST
- City
- MADISON
- State
- GA
- Zip code
- 306502054