- Enrollment id
- O20100415000400
- Enrollment state
- NY
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1205166816
- Multiple npi flag
- N
- Ccn
- 335655
- Associate id
- 6002943578
- Organization name
- PARK MANOR ACQUISITION II LLC
- Doing business as name
- MIDDLETOWN PARK REHABILITATION AND HEALTH CARE CENTER
- Incorporation date
- 2009-12-30
- Incorporation state
- NY
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- MIDDLETOWN PARK REHAB & HEALTH CARE CENTER
- Affiliation entity name
- EPIC HEALTHCARE MANAGEMENT
- Affiliation entity id
- 207
- Address line 1
- 121 DUNNING RD
- City
- MIDDLETOWN
- State
- NY
- Zip code
- 109402243