- Enrollment id
- O20260331001103
- Enrollment state
- IN
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1912930223
- Multiple npi flag
- N
- Ccn
- 155207
- Associate id
- 3173515509
- Organization name
- PULASKI MEMORIAL HOSPITAL
- Doing business as name
- MAJESTIC CARE OF NEW HAVEN
- Organization type structure
- GOVERNMENT
- Proprietary nonprofit
- N
- Nursing home provider name
- MAJESTIC CARE OF NEW HAVEN
- Affiliation entity name
- MAJESTIC CARE
- Affiliation entity id
- 331
- Address line 1
- 1201 DALY DR
- City
- NEW HAVEN
- State
- IN
- Zip code
- 467741891