- Enrollment id
- O20161024001462
- Enrollment state
- TN
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1558814095
- Multiple npi flag
- N
- Ccn
- 445171
- Associate id
- 6305124561
- Organization name
- THE WATERS OF SHELBYVILLE, LLC
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- THE WATERS OF SHELBYVILLE, LLC
- Affiliation entity name
- INFINITY HEALTHCARE CONSULTING
- Affiliation entity id
- 763
- Address line 1
- 835 UNION ST
- City
- SHELBYVILLE
- State
- TN
- Zip code
- 371602607