- Enrollment id
- O20220303000532
- Enrollment state
- SC
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1619644648
- Multiple npi flag
- N
- Ccn
- 425132
- Associate id
- 2567856883
- Organization name
- SC OPCO LLC
- Doing business as name
- RIDGELAND NURSING AND REHAB CENTER
- Incorporation date
- 2021-05-11
- Incorporation state
- NJ
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 1516 GRAYS HWY
- City
- RIDGELAND
- State
- SC
- Zip code
- 299365440