- Enrollment id
- O20100120000036
- Enrollment state
- NY
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1205822400
- Multiple npi flag
- N
- Ccn
- 335539
- Associate id
- 7214958263
- Organization name
- OUR LADY OF CONSOLATION CARE CENTER
- Incorporation date
- 1992-06-15
- Incorporation state
- NY
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- N
- Nursing home provider name
- OUR LADY OF CONSOLATION NURSING AND REHABILITATIVE CARE CENTER
- Address line 1
- 111 BEACH DRIVE
- City
- WEST ISLIP
- State
- NY
- Zip code
- 117954929