- Enrollment id
- O20031110000053
- Enrollment state
- FL
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1679560262
- Multiple npi flag
- N
- Ccn
- 105524
- Associate id
- 7810800596
- Organization name
- DEEP CREEK RNC, LLC
- Doing business as name
- PORT CHARLOTTE REHABILITATION CENTER
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- PORT CHARLOTTE REHABILITATION CENTER
- Affiliation entity name
- CLEAR CHOICE HEALTHCARE
- Affiliation entity id
- 149
- Address line 1
- 25325 RAMPART BLVD
- City
- PORT CHARLOTTE
- State
- FL
- Zip code
- 339836404