- Enrollment id
- O20130724000608
- Enrollment state
- NY
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1558704544
- Multiple npi flag
- N
- Ccn
- 335334
- Associate id
- 3274774880
- Organization name
- 150 RIVERSIDE OP LLC
- Doing business as name
- THE RIVERSIDE
- Incorporation date
- 2012-03-22
- Incorporation state
- NY
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- THE RIVERSIDE
- Affiliation entity name
- CARERITE CENTERS
- Affiliation entity id
- 110
- Address line 1
- 150 RIVERSIDE DR
- City
- NEW YORK
- State
- NY
- Zip code
- 100242298