- Enrollment id
- O20040209000143
- Enrollment state
- TX
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1609816206
- Multiple npi flag
- N
- Ccn
- 325116
- Associate id
- 5597675074
- Organization name
- MESCALERO CARE CENTER
- Incorporation state
- NM
- Organization type structure
- OTHER
- Organization other type text
- TRIBAL
- Proprietary nonprofit
- N
- Nursing home provider name
- MESCALERO CARE CENTER
- Address line 1
- 454 LIPAN AVE
- City
- MESCALERO
- State
- NM
- Zip code
- 88340