- Enrollment id
- O20100218000169
- Enrollment state
- NY
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1154471258
- Multiple npi flag
- N
- Ccn
- 335269
- Associate id
- 4587708235
- Organization name
- WARTBURG HOME OF THE EVANGELICAL LUTHERAN CHURCH
- Doing business as name
- WARTBURG NURSING HOME
- Incorporation date
- 1991-06-20
- Incorporation state
- NY
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- N
- Nursing home provider name
- THE WARTBURG HOME
- Address line 1
- 1 BRADLEY AVE
- City
- MT VERNON
- State
- NY
- Zip code
- 10552