- Enrollment id
- O20180604002768
- Enrollment state
- TN
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1578099784
- Multiple npi flag
- N
- Ccn
- 445331
- Associate id
- 5991060477
- Organization name
- GRACELAND NURSING OPERATOR LLC
- Incorporation date
- 2017-02-21
- Incorporation state
- DE
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- GRACELAND REHABILITATION AND NURSING CARE CENTER
- Address line 1
- 1250 FARROW RD
- City
- MEMPHIS
- State
- TN
- Zip code
- 381167116