- Enrollment id
- O20101130000011
- Enrollment state
- NY
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1508167230
- Multiple npi flag
- N
- Ccn
- 335401
- Associate id
- 8527254838
- Organization name
- SUFFOLK RESTORATIVE THERAPY & NURSING, LLC
- Doing business as name
- MOMENTUM AT SOUTH BAY FOR REHABILITATION & NURSING
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- MOMENTUM AT SOUTH BAY FOR REHABILATION AND NURSING
- Affiliation entity name
- PARAGON HEALTHNET
- Affiliation entity id
- 395
- Address line 1
- 340 E MAIN ST
- City
- EAST ISLIP
- State
- NY
- Zip code
- 117302820