- Enrollment id
- O20140217000024
- Enrollment state
- NY
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1720421019
- Multiple npi flag
- N
- Ccn
- 335445
- Associate id
- 5597994566
- Organization name
- DOJ OPERATIONS ASSOCIATES LLC
- Doing business as name
- TRIBORO CENTER FOR REHABILITATION AND NURSING
- Incorporation date
- 2012-11-21
- Incorporation state
- NY
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- TRIBORO CENTER FOR REHABILITATION AND NURSING
- Affiliation entity name
- CENTERS HEALTH CARE
- Affiliation entity id
- 127
- Address line 1
- 1160 TELLER AVE
- City
- BRONX
- State
- NY
- Zip code
- 104564145