- Enrollment id
- O20190621001155
- Enrollment state
- PA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1366904922
- Multiple npi flag
- N
- Ccn
- 396070
- Associate id
- 7315271517
- Organization name
- BSD CARE AT AJ LLC
- Doing business as name
- THE PINES AT PHILADELPHIA REHABILITATION AND HEALTHCARE CENTER
- Incorporation date
- 2019-03-26
- Incorporation state
- PA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Nursing home provider name
- THE PINES AT PHILADELPHIA REHAB AND HEALTHCARE CTR
- Affiliation entity name
- PARAMOUNT CARE CENTERS
- Affiliation entity id
- 774
- Address line 1
- 8410 ROOSEVELT BLVD
- City
- PHILADELPHIA
- State
- PA
- Zip code
- 191522012