- Enrollment id
- O20121114000183
- Enrollment state
- IL
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1215280045
- Multiple npi flag
- N
- Ccn
- 145864
- Associate id
- 7416108782
- Organization name
- FOREST EDGE HEALTHCARE & REHABILITATION CENTER LP
- Organization type structure
- PARTNERSHIP
- Proprietary nonprofit
- P
- Nursing home provider name
- BRIA OF FOREST EDGE
- Affiliation entity name
- BRIA HEALTH SERVICES
- Affiliation entity id
- 88
- Address line 1
- 8001S WESTERN AVE
- City
- CHICAGO
- State
- IL
- Zip code
- 606205930