- Enrollment id
- O20180606001480
- Enrollment state
- TN
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1760979371
- Multiple npi flag
- N
- Ccn
- 445465
- Associate id
- 6800151283
- Organization name
- COLUMBIA TN SNF LLC
- Doing business as name
- MAGNOLIA HEALTHCARE AND REHABILITATION CENTER
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- MAGNOLIA HEALTHCARE AND REHABILITATION CENTER
- Address line 1
- 1410 TROTWOOD AVE
- City
- COLUMBIA
- State
- TN
- Zip code
- 384014901