- Enrollment id
- O20220426000317
- Enrollment state
- TN
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1659948529
- Multiple npi flag
- N
- Ccn
- 445357
- Associate id
- 6103213970
- Organization name
- WATERS OF MCKENZIE A REHABILITATION & NURSING CENTER LLC
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- WATERS OF MCKENZIE A REHABILITATION & NURSING CTR
- Affiliation entity name
- INFINITY HEALTHCARE CONSULTING
- Affiliation entity id
- 763
- Address line 1
- 14510 HIGHWAY 79
- City
- MC KENZIE
- State
- TN
- Zip code
- 382017824