- Enrollment id
- O20181207000751
- Enrollment state
- NY
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1598249179
- Multiple npi flag
- N
- Ccn
- 335765
- Associate id
- 6204170533
- Organization name
- KINGSTON NH OPERATION LLC
- Doing business as name
- TEN BROECK CENTER FOR REHABILITATION & NURSING
- Incorporation date
- 2017-10-16
- Incorporation state
- NY
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- TEN BROECK CENTER FOR REHABILITATION & NURSING
- Address line 1
- 1 COMMONS DR
- City
- LAKE KATRINE
- State
- NY
- Zip code
- 124495149