- Enrollment id
- O20040315000081
- Enrollment state
- NY
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1780661785
- Multiple npi flag
- N
- Ccn
- 335294
- Associate id
- 6901795202
- Organization name
- LONG ISLAND CARE CENTER INC
- Incorporation date
- 1992-03-09
- Incorporation state
- NY
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Nursing home provider name
- LONG ISLAND CARE CENTER INC
- Affiliation entity name
- PARAGON HEALTHNET
- Affiliation entity id
- 395
- Address line 1
- 14461 38TH AVE
- City
- FLUSHING
- State
- NY
- Zip code
- 113545935