- Enrollment id
- O20170404002121
- Enrollment state
- TX
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1902341696
- Multiple npi flag
- N
- Ccn
- 455676
- Associate id
- 6709932049
- Organization name
- MEDINA COUNTY HOSPITAL DISTRICT
- Doing business as name
- COMMUNITY CARE CENTER OF HONDO
- Organization type structure
- OTHER
- Organization other type text
- HOSPITAL DISTRICT
- Proprietary nonprofit
- N
- Nursing home provider name
- COMMUNITY CARE CENTER OF HONDO
- Address line 1
- 2001 AVENUE E
- City
- HONDO
- State
- TX
- Zip code
- 788612533