- Enrollment id
- O20180208000120
- Enrollment state
- NY
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1801301254
- Multiple npi flag
- N
- Ccn
- 335673
- Associate id
- 9830459015
- Organization name
- FSNR SNF LLC
- Doing business as name
- FOUR SEASON'S NURSING AND REHABILITATION CENTER
- Incorporation date
- 2014-04-21
- Incorporation state
- DE
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- FOUR SEASONS NURSING AND REHABILITATION CENTER
- Affiliation entity name
- THE SHERMAN FAMILY
- Affiliation entity id
- 781
- Address line 1
- 1555 ROCKAWAY PKWY
- City
- BROOKLYN
- State
- NY
- Zip code
- 112364001