- Enrollment id
- O20110119000923
- Enrollment state
- MO
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1700186939
- Multiple npi flag
- N
- Ccn
- 265477
- Associate id
- 9234318593
- Organization name
- SPRINGFIELD HEALTHCARE MANAGEMENT LLC
- Doing business as name
- SPRINGFIELD SKILLED CARE CENTER
- Incorporation date
- 2010-07-09
- Incorporation state
- MO
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- SPRINGFIELD SKILLED CARE CENTER
- Affiliation entity name
- MGM HEALTHCARE
- Affiliation entity id
- 348
- Address line 1
- 2401 W GRAND ST
- City
- SPRINGFIELD
- State
- MO
- Zip code
- 658024967