- Enrollment id
- O20031016000019
- Enrollment state
- NY
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1679563464
- Multiple npi flag
- N
- Ccn
- 335840
- Associate id
- 9537071311
- Organization name
- NURSING CARE CENTER AT MEDFORD INC
- Doing business as name
- MEDFORD MULTICARE CENTER FOR LIVING
- Incorporation date
- 1998-05-20
- Incorporation state
- NY
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Nursing home provider name
- MEDFORD MULTICARE CENTER FOR LIVING
- Address line 1
- 3115 HORSEBLOCK RD
- City
- MEDFORD
- State
- NY
- Zip code
- 117632526