- Enrollment id
- O20180214002824
- Enrollment state
- NY
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1295242683
- Multiple npi flag
- N
- Ccn
- 335338
- Associate id
- 7416217302
- Organization name
- CLINTON SQUARE OPERATIONS LLC
- Doing business as name
- CLINTON SQUARE NURSING AND REHABILITATION
- Incorporation date
- 2017-12-18
- Incorporation state
- NY
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- BISHOP REHABILITATION AND NURSING CENTER
- Address line 1
- 918 JAMES ST
- City
- SYRACUSE
- State
- NY
- Zip code
- 132032500