- Enrollment id
- O20121113000156
- Enrollment state
- NY
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1174510648
- Multiple npi flag
- N
- Ccn
- 335502
- Associate id
- 7719138122
- Organization name
- GOLDEN GATE REHABILITATION & HEALTH CARE CENTER LLC
- Doing business as name
- GOLDEN GATE REHABILITATION AND HEALTH CARE CENTER
- Incorporation date
- 2000-05-26
- Incorporation state
- NY
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- GOLDEN GATE REHABILITATION & HEALTH CARE CENTER
- Affiliation entity name
- BENJAMIN LANDA
- Affiliation entity id
- 646
- Address line 1
- 191 BRADLEY AVE
- City
- STATEN ISLAND
- State
- NY
- Zip code
- 103145166