- Enrollment id
- O20171116002886
- Enrollment state
- NY
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1104355536
- Multiple npi flag
- N
- Ccn
- 335213
- Associate id
- 8527324938
- Organization name
- MASSAPEQUA CENTER LLC
- Doing business as name
- MASSAPEQUA CENTER REHABILITATION & NURSING
- Incorporation date
- 2016-09-15
- Incorporation state
- NY
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- MASSAPEQUA CENTER REHABILITATION & NURSING
- Address line 1
- 101 LOUDEN AVE
- City
- AMITYVILLE
- State
- NY
- Zip code
- 117012736