- Enrollment id
- O20221228002641
- Enrollment state
- NJ
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1093430928
- Multiple npi flag
- N
- Ccn
- 315261
- Associate id
- 8022488485
- Organization name
- LAKELAND OPERATOR LLC
- Doing business as name
- LAKELAND NURSING & REHAB
- Incorporation date
- 2021-09-29
- Incorporation state
- DE
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- LAKELAND NURSING & REHAB
- Affiliation entity name
- BEST CARE SERVICES
- Affiliation entity id
- 583
- Address line 1
- 25 5TH AVE
- City
- HASKELL
- State
- NJ
- Zip code
- 074201075