- Enrollment id
- O20130702000326
- Enrollment state
- NJ
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1306182159
- Multiple npi flag
- N
- Ccn
- 315042
- Associate id
- 3577718030
- Organization name
- 521 PINE BROOK OPERATING LLC
- Doing business as name
- LINCOLN PARK RENAISSANCE
- Incorporation date
- 2012-09-06
- Incorporation state
- NJ
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- LINCOLN PARK RENAISSANCE
- Affiliation entity name
- CENTER MANAGEMENT GROUP
- Affiliation entity id
- 619
- Address line 1
- 521 PINE BROOK RD
- City
- LINCOLN PARK
- State
- NJ
- Zip code
- 070351801