- Enrollment id
- O20121107000150
- Enrollment state
- NY
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1720249493
- Multiple npi flag
- N
- Ccn
- 335571
- Associate id
- 7719895028
- Organization name
- ROCKAWAY CARE CENTER LLC
- Incorporation date
- 2008-06-24
- Incorporation state
- NY
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- ROCKAWAY CARE CENTER
- Address line 1
- 353 BEACH 48TH ST
- City
- FAR ROCKAWAY
- State
- NY
- Zip code
- 116911120