- Enrollment id
- O20111219000548
- Enrollment state
- NY
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1205939667
- Multiple npi flag
- N
- Ccn
- 335020
- Associate id
- 1355232588
- Organization name
- HEBREW HOME FOR THE AGED AT RIVERDALE
- Incorporation date
- 1917-10-10
- Incorporation state
- NY
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- N
- Nursing home provider name
- HEBREW HOME FOR THE AGED AT RIVERDALE
- Address line 1
- 5901 PALISADE AVE
- City
- BRONX
- State
- NY
- Zip code
- 104711205