- Enrollment id
- O20231030001829
- Enrollment state
- MT
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1780398149
- Multiple npi flag
- N
- Ccn
- 275035
- Associate id
- 8820444730
- Organization name
- MISSOULA SNF OPERATIONS LLC
- Doing business as name
- MISSOULA HEALTH & REHABILITATION CENTER
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- MISSOULA HEALTH & REHABILITATION CENTER
- Affiliation entity name
- EVERGREEN HEALTHCARE GROUP
- Affiliation entity id
- 846
- Address line 1
- 3018 RATTLESNAKE DR
- City
- MISSOULA
- State
- MT
- Zip code
- 598026101