- Enrollment id
- O20190828003995
- Enrollment state
- SD
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1881250397
- Multiple npi flag
- N
- Ccn
- 435051
- Associate id
- 9032447099
- Organization name
- ARROWHEAD SD SKILLED NURSING FACILITY LLC
- Doing business as name
- AVANTARA ARROWHEAD
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- AVANTARA ARROWHEAD
- Affiliation entity name
- LEGACY HEALTHCARE
- Affiliation entity id
- 306
- Address line 1
- 2500 ARROWHEAD DR
- City
- RAPID CITY
- State
- SD
- Zip code
- 577024225