- Enrollment id
- O20100513000003
- Enrollment state
- NY
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1235174541
- Multiple npi flag
- N
- Ccn
- 335143
- Associate id
- 8820126840
- Organization name
- MEADOW PARK REHABILITATION & HEALTH CARE CENTER, LLC
- Incorporation date
- 1999-12-22
- Incorporation state
- NY
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- MEADOW PARK REHABILITATION AND HEALTH CENTER LLC
- Affiliation entity name
- BENJAMIN LANDA
- Affiliation entity id
- 646
- Address line 1
- 7810 164TH ST
- City
- FRESH MEADOWS
- State
- NY
- Zip code
- 113661229