- Enrollment id
- O20031218000899
- Enrollment state
- IA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1790772341
- Multiple npi flag
- N
- Ccn
- 165151
- Associate id
- 4385541002
- Organization name
- LEXINGTON SQUARE LLC
- Doing business as name
- MISSISSIPPI VALLEY HEALTHCARE & REHABILITATION CENTER
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- MISSISSIPPI VALLEY
- Address line 1
- 500 MESSENGER RD
- City
- KEOKUK
- State
- IA
- Zip code
- 526322117