- Enrollment id
- O20030127000000
- Enrollment state
- NY
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1063419612
- Multiple npi flag
- N
- Ccn
- 335165
- Associate id
- 6901714609
- Organization name
- NEW SURFSIDE NURSING HOME LLC
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- PREMIER NURSING AND REHAB CENTER OF FAR ROCKAWAY
- Affiliation entity name
- BENJAMIN LANDA
- Affiliation entity id
- 646
- Address line 1
- 2241 NEW HAVEN AVE
- City
- FAR ROCKAWAY
- State
- NY
- Zip code
- 116912538