- Enrollment id
- O20080111000629
- Enrollment state
- FL
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1598769200
- Multiple npi flag
- N
- Ccn
- 105117
- Associate id
- 1355422643
- Organization name
- SENIOR HEALTH-SOUTH HERITAGE, LLC
- Doing business as name
- SOUTH HERITAGE HEALTH & REHABILITATION CENTER
- Incorporation date
- 2000-11-20
- Incorporation state
- FL
- Organization type structure
- LLC
- Proprietary nonprofit
- N
- Nursing home provider name
- SOUTH HERITAGE HEALTH & REHABILITATION CENTER
- Affiliation entity name
- SENIOR HEALTH SOUTH
- Affiliation entity id
- 729
- Address line 1
- 718 22ND AVE S
- City
- ST PETERSBURG
- State
- FL
- Zip code
- 337053004