- Enrollment id
- O20190213002136
- Enrollment state
- NY
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1346704905
- Multiple npi flag
- N
- Ccn
- 335336
- Associate id
- 2163760349
- Organization name
- CHAPIN ACQUISITION I LLC
- Doing business as name
- MARGARET TIETZ NURSING AND REHABILITATION CENTER
- Incorporation date
- 2017-11-24
- Incorporation state
- NY
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- MARGARET TIETZ NURSING AND REHABILITATION CENTER
- Affiliation entity name
- CASSENA CARE
- Affiliation entity id
- 119
- Address line 1
- 16411 CHAPIN PKWY
- City
- JAMAICA
- State
- NY
- Zip code
- 114321816