- Enrollment id
- O20081013000234
- Enrollment state
- NJ
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1801042460
- Multiple npi flag
- N
- Ccn
- 315271
- Associate id
- 1658449020
- Organization name
- CARNEYS POINT REHABILITATION AND NURSING CENTER LLC
- Doing business as name
- AUTUMN LAKE HEALTHCARE AT MEMORIAL BRIDGE
- Incorporation date
- 2007-10-18
- Incorporation state
- NY
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- AUTUMN LAKE HEALTHCARE AT MEMORIAL BRIDGE
- Affiliation entity name
- AUTUMN LAKE HEALTHCARE
- Affiliation entity id
- 56
- Address line 1
- 201 5TH AVE
- City
- PENNSGROVE
- State
- NJ
- Zip code
- 080691059