- Enrollment id
- O20181227001986
- Enrollment state
- IL
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1023589470
- Multiple npi flag
- N
- Ccn
- 145715
- Associate id
- 7012252786
- Organization name
- WHEATON VILLAGE NURSING AND REHABILITATION CENTER LLC
- Doing business as name
- WHEATON VILLAGE NURSING AND REHABILITATION CENTER
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- WHEATON VILLAGE NRSG & RHB CTR
- Affiliation entity name
- ATIED ASSOCIATES
- Affiliation entity id
- 53
- Address line 1
- 1325 MANCHESTER RD
- City
- WHEATON
- State
- IL
- Zip code
- 601874760