- Enrollment id
- O20240326001625
- Enrollment state
- FL
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1801672670
- Multiple npi flag
- N
- Ccn
- 105824
- Associate id
- 3971940917
- Organization name
- GREENVILLE OPCO LLC
- Doing business as name
- GREENVILLE NURSING AND REHAB CENTER
- Incorporation date
- 2023-07-21
- Incorporation state
- DE
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- GREENVILLE NURSING AND REHAB CENTER
- Affiliation entity name
- ELIYAHU MIRLIS
- Affiliation entity id
- 710
- Address line 1
- 13455 W US 90
- City
- GREENVILLE
- State
- FL
- Zip code
- 323314318