- Enrollment id
- O20020916000010
- Enrollment state
- NY
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1922004282
- Multiple npi flag
- N
- Ccn
- 335232
- Associate id
- 2264349000
- Organization name
- DEWITT REHABILITATION AND NURSING CENTER INC
- Doing business as name
- UPPER EAST SIDE REHABILITATION AND NURSING CENTER
- Incorporation date
- 2002-08-09
- Incorporation state
- NY
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Nursing home provider name
- UPPER EAST SIDE REHABILITATION AND NURSING CENTER
- Affiliation entity name
- CASSENA CARE
- Affiliation entity id
- 119
- Address line 1
- 211 E 79TH ST
- City
- NEW YORK
- State
- NY
- Zip code
- 100750819