- Enrollment id
- O20180706000651
- Enrollment state
- FL
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1629574884
- Multiple npi flag
- N
- Ccn
- 105813
- Associate id
- 2567718406
- Organization name
- SAIL NURSING AND REHABILITATION CENTER, LLC
- Doing business as name
- PARK RIDGE NURSING CENTER
- Incorporation date
- 2018-03-28
- Incorporation state
- FL
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- PARK RIDGE NURSING CENTER
- Affiliation entity name
- MAXIMUS HEALTHCARE GROUP
- Affiliation entity id
- 338
- Address line 1
- 730 COLLEGE ST
- City
- JACKSONVILLE
- State
- FL
- Zip code
- 322043313