- Enrollment id
- O20161110002142
- Enrollment state
- NY
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1699225169
- Multiple npi flag
- N
- Ccn
- 335462
- Associate id
- 8123307345
- Organization name
- TCPRNC, LLC
- Doing business as name
- THE PLAZA REHAB AND NURSING CENTER
- Incorporation date
- 2015-08-27
- Incorporation state
- NY
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- THE PLAZA REHAB AND NURSING CENTER
- Affiliation entity name
- CITADEL CARE CENTERS
- Affiliation entity id
- 146
- Address line 1
- 100 W KINGSBRIDGE RD
- City
- BRONX
- State
- NY
- Zip code
- 104683961