- Enrollment id
- O20180723001580
- Enrollment state
- NY
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1013424506
- Multiple npi flag
- N
- Ccn
- 335739
- Associate id
- 0143577155
- Organization name
- S&J OPERATIONAL LLC
- Doing business as name
- LUXOR NURSING AND REHABILITATION AT MILLS POND
- Incorporation date
- 2018-01-08
- Incorporation state
- NY
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- LUXOR NURSING & REHABILITATION AT MILLS POND
- Affiliation entity name
- CARERITE CENTERS
- Affiliation entity id
- 110
- Address line 1
- 273 MORICHES RD
- City
- SAINT JAMES
- State
- NY
- Zip code
- 117802117