- Enrollment id
- O20031007000025
- Enrollment state
- NY
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1386631547
- Multiple npi flag
- N
- Ccn
- 335694
- Associate id
- 8426966557
- Organization name
- BROOKHAVEN HEALTH CARE FACILITY LLC
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- BROOKHAVEN HEALTH CARE FACILITY, LLC
- Affiliation entity name
- THE MCGUIRE GROUP
- Affiliation entity id
- 510
- Address line 1
- 801 GAZZOLA DR
- City
- EAST PATCHOGUE
- State
- NY
- Zip code
- 117724900