- Enrollment id
- O20090506000196
- Enrollment state
- NY
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1497994800
- Multiple npi flag
- Y
- Ccn
- 335648
- Associate id
- 1951459676
- Organization name
- DITMAS PARK REHABILITATION & CARE CENTER LLC
- Doing business as name
- DITMAS PARK REHAB & CARE CENTER
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- DITMAS PARK CARE CENTER
- Address line 1
- 2107 DITMAS AVE
- City
- BROOKLYN
- State
- NY
- Zip code
- 112266903