- Enrollment id
- O20240329002049
- Enrollment state
- VA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1750094033
- Multiple npi flag
- N
- Ccn
- 495156
- Associate id
- 7012355878
- Organization name
- OLD SOUTHWEST HEALTH AND REHABILITATION LLC
- Doing business as name
- OLD SOUTHWEST HEALTH AND REHABILITATION
- Incorporation date
- 2022-11-30
- Incorporation state
- VA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- OLD SOUTHWEST HEALTH AND REHABILITATION
- Affiliation entity name
- EASTERN HEALTHCARE GROUP
- Affiliation entity id
- 608
- Address line 1
- 324 KING GEORGE AVE SW
- City
- ROANOKE
- State
- VA
- Zip code
- 240165213