- Enrollment id
- O20190114002862
- Enrollment state
- KY
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1497243455
- Multiple npi flag
- N
- Ccn
- 185230
- Associate id
- 8729324603
- Organization name
- LANDMARK OF ELKHORN CITY REHABILITATION AND NURSING CENTER
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 945 W RUSSELL ST
- City
- ELKHORN CITY
- State
- KY
- Zip code
- 415229032