- Enrollment id
- O20091130000061
- Enrollment state
- NJ
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1790784304
- Multiple npi flag
- N
- Ccn
- 315426
- Associate id
- 0941349237
- Organization name
- MILLENNIUM HEALTHCARE CENTERS, LLC
- Doing business as name
- CARE ONE AT RIDGEWOOD AVENUE
- Incorporation date
- 1999-12-23
- Incorporation state
- NJ
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- CAREONE AT RIDGEWOOD AVENUE
- Affiliation entity name
- CAREONE
- Affiliation entity id
- 109
- Address line 1
- 90 W RIDGEWOOD AVE
- City
- PARAMUS
- State
- NJ
- Zip code
- 076522270