- Enrollment id
- O20160503002500
- Enrollment state
- OH
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1801254883
- Multiple npi flag
- N
- Ccn
- 366202
- Associate id
- 7911206511
- Organization name
- CRYSTAL CARE OF IRONTON, LLC
- Doing business as name
- CRYSTAL CARE OF COAL GROVE
- Incorporation date
- 2016-02-01
- Incorporation state
- OH
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- CRYSTAL CARE OF COAL GROVE
- Affiliation entity name
- HILLSTONE HEALTHCARE
- Affiliation entity id
- 271
- Address line 1
- 813 1/2 MARION PIKE
- City
- COAL GROVE
- State
- OH
- Zip code
- 456383070