- Enrollment id
- O20180507000552
- Enrollment state
- TX
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1881192268
- Multiple npi flag
- N
- Ccn
- 675067
- Associate id
- 6305067539
- Organization name
- COUNTY OF THROCKMORTON
- Doing business as name
- AVIR AT GAINESVILLE
- Organization type structure
- GOVERNMENT
- Proprietary nonprofit
- N
- Nursing home provider name
- AVIR AT GAINESVILLE
- Affiliation entity name
- AVIR HEALTH GROUP
- Affiliation entity id
- 719
- Address line 1
- 1900 ONEAL ST
- City
- GAINESVILLE
- State
- TX
- Zip code
- 762403604