- Enrollment id
- O20220126003194
- Enrollment state
- TN
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1669136123
- Multiple npi flag
- N
- Ccn
- 445295
- Associate id
- 5698167567
- Organization name
- HOLSTON MANOR SNF OPERATIONS LLC
- Doing business as name
- HOLSTON REHABILITATION AND CARE CENTER
- Incorporation date
- 2021-10-01
- Incorporation state
- TN
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- HOLSTON REHABILITATION AND CARE CENTER
- Affiliation entity name
- VENZA CARE MANAGEMENT
- Affiliation entity id
- 614
- Address line 1
- 3641 MEMORIAL BLVD
- City
- KINGSPORT
- State
- TN
- Zip code
- 376643422