- Enrollment id
- O20251017000591
- Enrollment state
- TX
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1538965330
- Multiple npi flag
- N
- Ccn
- 675371
- Associate id
- 8022505528
- Organization name
- 1102 RIVER ROAD OPCO LLC
- Doing business as name
- AVIR AT BOERNE
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- AVIR AT BOERNE
- Affiliation entity name
- AVIR HEALTH GROUP
- Affiliation entity id
- 719
- Address line 1
- 1102 RIVER RD
- City
- BOERNE
- State
- TX
- Zip code
- 780062436