- Enrollment id
- O20101006000668
- Enrollment state
- NY
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1225029234
- Multiple npi flag
- N
- Ccn
- 335831
- Associate id
- 4688707847
- Organization name
- FULTON COMMONS CARE CENTER, INC.
- Incorporation date
- 1999-12-10
- Incorporation state
- NY
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Nursing home provider name
- FULTON COMMONS CARE CENTER INC
- Affiliation entity name
- THE GRAND HEALTHCARE
- Affiliation entity id
- 509
- Address line 1
- 60 MERRICK AVE
- City
- EAST MEADOW
- State
- NY
- Zip code
- 115541578