- Enrollment id
- O20260226002845
- Enrollment state
- FL
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1518757939
- Multiple npi flag
- N
- Ccn
- 105138
- Associate id
- 6507347515
- Organization name
- 5377 JAX OPCO LLC
- Doing business as name
- JACKSONVILLE REHABILITATION AND NURSING
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- JACKSONVILLE REHABILITATION AND NURSING
- Affiliation entity name
- ELIYAHU MIRLIS
- Affiliation entity id
- 710
- Address line 1
- 5377 MONCRIEF RD
- City
- JACKSONVILLE
- State
- FL
- Zip code
- 322093159