- Enrollment id
- O20100120000007
- Enrollment state
- NY
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1023097698
- Multiple npi flag
- N
- Ccn
- 335455
- Associate id
- 9335281997
- Organization name
- CARMEL RICHMOND NURSING HOME INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- N
- Nursing home provider name
- CARMEL RICHMOND HEALTHCARE AND REHABILITATION CENTER
- Affiliation entity name
- ARCHCARE
- Affiliation entity id
- 43
- Address line 1
- 88 OLD TOWN ROAD
- City
- STATEN ISLAND
- State
- NY
- Zip code
- 103044212