| Name | Value |
|---|---|
| PROVIDER TYPE | Nursing & Custodial Care Facilities |
| CLASSIFICATION | Intermediate Care Facility, Mental Illness |
| DEFINITION | A nursing facility that provides an intermediate level of nursing care to individuals whose functional abilities are significantly compromise by mental illness. |
| STATUS | Active |
| X12 CODE | 310500000X |
| INDIVIDUAL/NON | NON-INDIVIDUAL |
| MASTER ENTRY FOR VUID | YES |
| VUID | 5252756 |
| EFFECTIVE DATE/TIME |
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