- Enrollment id
- O20120628000104
- Enrollment state
- NY
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1487917712
- Multiple npi flag
- N
- Ccn
- 335320
- Associate id
- 0345405106
- Organization name
- SPRAIN BROOK MANOR REHAB, LLC
- Doing business as name
- SPRAIN BROOK MANOR NURSING HOME
- Incorporation date
- 2012-04-27
- Incorporation state
- NY
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- SPRAIN BROOK MANOR REHAB
- Address line 1
- 77 JACKSON AVE
- City
- SCARSDALE
- State
- NY
- Zip code
- 105833140