- Enrollment id
- O20220622000492
- Enrollment state
- FL
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1619621836
- Multiple npi flag
- N
- Ccn
- 106117
- Associate id
- 5890174866
- Organization name
- OLIVE BRANCH OPERATING INVESTMENTS, LLC
- Doing business as name
- OLIVE BRANCH HEALTH AND REHABILITATION CENTER
- Incorporation date
- 2021-12-09
- Incorporation state
- DE
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- OLIVE BRANCH HEALTH AND REHABILITATION CENTER
- Address line 1
- 8325 UNIVERSITY PARKWAY
- City
- PENSACOLA
- State
- FL
- Zip code
- 325144949