- Enrollment id
- O20140423002159
- Enrollment state
- NC
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1629494059
- Multiple npi flag
- N
- Ccn
- 345159
- Associate id
- 0648403873
- Organization name
- LINCOLNTON REHABILITATION CENTER LLC
- Doing business as name
- LINCOLNTON REHABILITATION CENTER
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- LINCOLNTON REHABILITATION CENTER
- Affiliation entity name
- SOVEREIGN HEALTHCARE HOLDINGS
- Affiliation entity id
- 482
- Address line 1
- 1410 E GASTON ST
- City
- LINCOLNTON
- State
- NC
- Zip code
- 280924400