- Enrollment id
- O20161128001603
- Enrollment state
- PA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1821444209
- Multiple npi flag
- N
- Ccn
- 396141
- Associate id
- 8022397587
- Organization name
- FOX SUBACUTE AT SOUTH PHILADELPHIA LLC
- Doing business as name
- PHARMERICA
- Incorporation date
- 2015-11-11
- Incorporation state
- PA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- FOX SUBACUTE AT SOUTH PHILADELPHIA
- Address line 1
- 1930 SOUTH BROAD STREET
- City
- PHILADELPHIA
- State
- PA
- Zip code
- 191452328