- Enrollment id
- O20070419000206
- Enrollment state
- NY
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1417952417
- Multiple npi flag
- N
- Ccn
- 335239
- Associate id
- 9032191259
- Organization name
- CLOVE LAKES HEALTH CARE AND REHABILITATION CENTER INC.
- Incorporation date
- 1997-07-01
- Incorporation state
- NY
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Nursing home provider name
- CLOVE LAKES HEALTH CARE AND REHABILITATION CENTER, INC
- Affiliation entity name
- INFINITE CARE
- Affiliation entity id
- 578
- Address line 1
- 25 FANNING ST
- City
- STATEN ISLAND
- State
- NY
- Zip code
- 103145307