- Enrollment id
- O20260422002188
- Enrollment state
- GA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1992666291
- Multiple npi flag
- N
- Ccn
- 115561
- Associate id
- 1557838026
- Organization name
- TUCKER PARK CROSSING OF JOURNEY LLC
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- TUCKER PARK CROSSING OF JOURNEY LLC
- Affiliation entity name
- JOURNEY HEALTHCARE
- Affiliation entity id
- 766
- Address line 1
- 4608 LAWRENCEVILLE HWY
- City
- TUCKER
- State
- GA
- Zip code
- 300842903