- Enrollment id
- O20211201002213
- Enrollment state
- AR
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1962087825
- Multiple npi flag
- N
- Ccn
- 045345
- Associate id
- 5597155754
- Organization name
- WHEELER AVENUE OPERATING LLC
- Doing business as name
- BLOSSOMS AT FORT SMITH REHAB & NURSING CENTER
- Incorporation date
- 2020-12-01
- Incorporation state
- AR
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- THE BLOSSOMS AT FORT SMITH REHAB & NURSING CENTER
- Affiliation entity name
- THE BLOSSOMS REHAB & NURSING CENTER
- Affiliation entity id
- 505
- Address line 1
- 5301 WHEELER AVENUE
- City
- FORT SMITH
- State
- AR
- Zip code
- 729018339