- Enrollment id
- O20140918000406
- Enrollment state
- NY
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1801206156
- Multiple npi flag
- N
- Ccn
- 335513
- Associate id
- 1456570704
- Organization name
- SHOREFRONT OPERATING LLC
- Doing business as name
- SEAGATE REHABILITATION AND NURSING CENTER
- Incorporation date
- 2012-09-13
- Incorporation state
- NY
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- SEAGATE REHABILITATION AND NURSING CENTER
- Affiliation entity name
- EXCELSIOR CARE GROUP
- Affiliation entity id
- 217
- Address line 1
- 3015W 29TH ST
- City
- BROOKLYN
- State
- NY
- Zip code
- 112241901