- Enrollment id
- O20251001003324
- Enrollment state
- GA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1982497970
- Multiple npi flag
- N
- Ccn
- 115592
- Associate id
- 1557867249
- Organization name
- 233 CARROLLTON OPCO LLC
- Doing business as name
- COUNTRYSIDE POST ACUTE
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- COUNTRYSIDE POST ACUTE
- Address line 1
- 233 CARROLLTON ST
- City
- BUCHANAN
- State
- GA
- Zip code
- 301134917