- Enrollment id
- O20160902000400
- Enrollment state
- SC
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1851379481
- Multiple npi flag
- N
- Ccn
- 425093
- Associate id
- 5991091779
- Organization name
- CARLYLE SENIOR CARE OF FORK, LLC
- Doing business as name
- CARLYLE SENIOR CARE OF FORK
- Incorporation date
- 2016-06-22
- Incorporation state
- SC
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- CARLYLE SENIOR CARE OF FORK
- Affiliation entity name
- CARLYLE SENIOR CARE
- Affiliation entity id
- 599
- Address line 1
- 1727 BUCK SWAMP RD
- City
- FORK
- State
- SC
- Zip code
- 295436116