- Enrollment id
- O20100422000018
- Enrollment state
- NY
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1366438418
- Multiple npi flag
- N
- Ccn
- 335716
- Associate id
- 8123155249
- Organization name
- FOREST MANOR CARE CENTER INC
- Doing business as name
- GLEN COVE CENTER FOR NURSING & REHAB
- Incorporation date
- 1998-03-31
- Incorporation state
- NY
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Nursing home provider name
- GLEN COVE CENTER FOR NURSING AND REHABILITATION
- Affiliation entity name
- PARAGON HEALTHNET
- Affiliation entity id
- 395
- Address line 1
- 6 MEDICAL PLZ
- City
- GLEN COVE
- State
- NY
- Zip code
- 115422108