- Enrollment id
- O20210512002476
- Enrollment state
- IA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1902481153
- Multiple npi flag
- N
- Ccn
- 165373
- Associate id
- 6406265933
- Organization name
- DT VALLEY LLC
- Doing business as name
- AZRIA HEALTH LONGVIEW
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- AZRIA HEALTH LONGVIEW
- Affiliation entity name
- AZRIA HEALTH
- Affiliation entity id
- 64
- Address line 1
- 1010 LONGVIEW RD
- City
- MISSOURI VALLEY
- State
- IA
- Zip code
- 515551227