- Enrollment id
- O20141119000460
- Enrollment state
- FL
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1720082688
- Multiple npi flag
- N
- Ccn
- 105271
- Associate id
- 4587886908
- Organization name
- BOCA CIEGA REHABILITATION CENTER LLC
- Doing business as name
- BOCA CIEGA CENTER
- Incorporation date
- 2008-09-18
- Incorporation state
- FL
- Organization type structure
- LLC
- Proprietary nonprofit
- N
- Nursing home provider name
- BOCA CIEGA CENTER
- Affiliation entity name
- HEARTHSTONE SENIOR COMMUNITIES
- Affiliation entity id
- 262
- Address line 1
- 1414 59TH STREET SOUTH
- Address line 2
- BOCA CIEGA CENTER
- City
- GULFPORT
- State
- FL
- Zip code
- 337073352