- Enrollment id
- O20240125002659
- Enrollment state
- SC
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1770285710
- Multiple npi flag
- N
- Ccn
- 425118
- Associate id
- 5395198360
- Organization name
- BENNETTSVILLE HEALTH CARE LLC
- Doing business as name
- BENNETTSVILLE HEALTH AND REHABILITATION CENTER
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- BENNETTSVILLE HEALTH AND REHABILITATION CENTER
- Affiliation entity name
- FUNDAMENTAL HEALTHCARE
- Affiliation entity id
- 231
- Address line 1
- 710 HIGHWAY 15-401 BYP W
- City
- BENNETTSVILLE
- State
- SC
- Zip code
- 295123641