- Enrollment id
- O20161109002185
- Enrollment state
- TN
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1821542879
- Multiple npi flag
- N
- Ccn
- 445145
- Associate id
- 3870872112
- Organization name
- WATERS OF WINCHESTER LLC
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- HERITAGE PLACE CARE & REHABILITATION LLC
- Affiliation entity name
- INFINITY HEALTHCARE CONSULTING
- Affiliation entity id
- 763
- Address line 1
- 1360 BYPASS RD
- City
- WINCHESTER
- State
- TN
- Zip code
- 373982332