- Enrollment id
- O20111130000086
- Enrollment state
- NY
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1326117045
- Multiple npi flag
- N
- Ccn
- 335317
- Associate id
- 1759416175
- Organization name
- PARK TERRACE CARE CENTER INC
- Incorporation date
- 1990-01-01
- Incorporation state
- NY
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Nursing home provider name
- PARK TERRACE CARE CENTER
- Address line 1
- 5920 VAN DOREN ST
- City
- CORONA
- State
- NY
- Zip code
- 113684018