- Enrollment id
- O20170622002037
- Enrollment state
- TX
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1588103238
- Multiple npi flag
- N
- Ccn
- 676132
- Associate id
- 3072412725
- Organization name
- EASTLAND MEMORIAL HOSPITAL DISTRICT
- Doing business as name
- AVIR AT FORT WORTH
- Organization type structure
- GOVERNMENT
- Proprietary nonprofit
- N
- Nursing home provider name
- AVIR AT FORT WORTH
- Affiliation entity name
- AVIR HEALTH GROUP
- Affiliation entity id
- 719
- Address line 1
- 7100 TRAIL LAKE DR
- City
- FORT WORTH
- State
- TX
- Zip code
- 761231969