- Enrollment id
- O20250624003450
- Enrollment state
- MO
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1508668708
- Multiple npi flag
- N
- Ccn
- 265509
- Associate id
- 6103338280
- Organization name
- SOUTH COUNTY HEALTH CARE CENTER, L.L.C.
- Doing business as name
- SOUTH COUNTY HEALTH CARE CENTER
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- SOUTH COUNTY HEALTH CARE CENTER
- Affiliation entity name
- RELIANT CARE MANAGEMENT
- Affiliation entity id
- 446
- Address line 1
- 1101 W OUTER 21 RD
- City
- ARNOLD
- State
- MO
- Zip code
- 630104644