- Enrollment id
- O20181023003210
- Enrollment state
- NJ
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1508348400
- Multiple npi flag
- N
- Ccn
- 315434
- Associate id
- 8628321569
- Organization name
- FAMILY OF CARING HEALTHCARE AT RIDGEWOOD, LLC
- Incorporation date
- 2018-07-11
- Incorporation state
- NJ
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- FAMILY OF CARING HEALTHCARE AT RIDGEWOOD
- Affiliation entity name
- FAMILY OF CARING HEALTHCARE
- Affiliation entity id
- 220
- Address line 1
- 304 S VAN DIEN AVENUE
- City
- RIDGEWOOD
- State
- NJ
- Zip code
- 074505200