- Enrollment id
- O20181204003199
- Enrollment state
- MA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1982179610
- Multiple npi flag
- N
- Ccn
- 225532
- Associate id
- 6406190347
- Organization name
- BEAR MT MATTAPAN LLC
- Doing business as name
- MATTAPAN HEALTH AND REHABILITATION CENTER
- Incorporation state
- MA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- CARE VILLAGE AT MATTAPAN
- Address line 1
- 405 RIVER ST
- City
- MATTAPAN
- State
- MA
- Zip code
- 021262210