- Enrollment id
- O20120109000446
- Enrollment state
- NY
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1851486914
- Multiple npi flag
- N
- Ccn
- 335498
- Associate id
- 2466628730
- Organization name
- GRANDELL REHAB & NURSING CTR INC
- Incorporation date
- 1996-12-01
- Incorporation state
- NY
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Nursing home provider name
- GRANDELL REHABILITATION AND NURSING CENTER
- Address line 1
- 645 W BROADWAY
- City
- LONG BEACH
- State
- NY
- Zip code
- 115612956