- Enrollment id
- O20151028002064
- Enrollment state
- IN
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1659366128
- Multiple npi flag
- N
- Ccn
- 155523
- Associate id
- 1951396605
- Organization name
- PUTNAM COUNTY HOSPITAL
- Doing business as name
- RICHLAND BEAN BLOSSOM HEALTH CARE CENTER
- Organization type structure
- OTHER
- Organization other type text
- INDIANA COUNTY HOSPIAL
- Proprietary nonprofit
- N
- Nursing home provider name
- RICHLAND BEAN BLOSSOM HEALTH CARE CENTER
- Address line 1
- 5911 W STATE ROAD 46, PO BOX 537
- City
- ELLETTSVILLE
- State
- IN
- Zip code
- 474290537