- Enrollment id
- O20150206001857
- Enrollment state
- NY
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1366847451
- Multiple npi flag
- N
- Ccn
- 335516
- Associate id
- 8921323387
- Organization name
- ATLANTIS OPERATING LLC
- Doing business as name
- THE PHOENIX REHABILITATION AND NURSING CENTER
- Incorporation date
- 2013-09-03
- Incorporation state
- NY
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- THE PHOENIX REHABILITATION AND NURSING CENTER
- Affiliation entity name
- CARERITE CENTERS
- Affiliation entity id
- 110
- Address line 1
- 140 SAINT EDWARDS ST
- City
- BROOKLYN
- State
- NY
- Zip code
- 112013904