- Enrollment id
- O20080620000153
- Enrollment state
- MS
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1700872579
- Multiple npi flag
- N
- Ccn
- 255213
- Associate id
- 9436220324
- Organization name
- MEADVILLE LLC
- Doing business as name
- MEADVILLE CONVALESCENT HOME
- Incorporation date
- 2001-12-26
- Incorporation state
- MS
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- MEADVILLE CONVALESCENT HOME
- Affiliation entity name
- CAVALIER HEALTHCARE
- Affiliation entity id
- 691
- Address line 1
- 300 HIGHWAY 556
- Address line 2
- MEADVILLE CONVALESCENT HOME
- City
- MEADVILLE
- State
- MS
- Zip code
- 396539126