- Enrollment id
- O20241126000200
- Enrollment state
- MO
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1780404012
- Multiple npi flag
- N
- Ccn
- 265668
- Associate id
- 3870028004
- Organization name
- CARRIE ELLIGSON GIETNER HEALTH CARE CENTER LLC
- Doing business as name
- CARRIE ELLIGSON GIETNER HEALTH CARE CENTER
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- CARRIE ELLIGSON GIETNER HEALTH CARE CENTER
- Affiliation entity name
- RELIANT CARE MANAGEMENT
- Affiliation entity id
- 446
- Address line 1
- 5000 S BROADWAY
- City
- SAINT LOUIS
- State
- MO
- Zip code
- 631112015