- Enrollment id
- O20111201000587
- Enrollment state
- NY
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1194733642
- Multiple npi flag
- N
- Ccn
- 335146
- Associate id
- 9931373925
- Organization name
- FAIRVIEW NURSING CARE CENTER INC
- Doing business as name
- FAIRVIEW NURSING HOME
- Incorporation date
- 1991-01-01
- Incorporation state
- NY
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Nursing home provider name
- FAIRVIEW NURSING CARE CENTER INC.
- Address line 1
- 69 70 GRAND CENTRAL PKWY
- City
- FOREST HILLS
- State
- NY
- Zip code
- 113753949