- Enrollment id
- O20170825001851
- Enrollment state
- NY
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1285150771
- Multiple npi flag
- N
- Ccn
- 335751
- Associate id
- 4880966852
- Organization name
- YGC AT WOODYCREST LLC
- Doing business as name
- HIGHBRIDGE WOODYCREST CENTER
- Incorporation date
- 2016-03-01
- Incorporation state
- NY
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- HIGHBRIDGE WOODYCREST CENTER
- Affiliation entity name
- HIGHBRIDGE HEALTHCARE
- Affiliation entity id
- 269
- Address line 1
- 936 WOODYCREST AVE
- City
- BRONX
- State
- NY
- Zip code
- 104525503