- Enrollment id
- O20090505000013
- Enrollment state
- IL
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1336385764
- Multiple npi flag
- N
- Ccn
- 145806
- Associate id
- 2264580018
- Organization name
- WARREN PARK HEALTH AND LIVING CENTER, LLC
- Doing business as name
- WARREN PARK HEALTH AND LIVING CENTER
- Incorporation date
- 2008-05-01
- Incorporation state
- IL
- Organization type structure
- PARTNERSHIP
- Proprietary nonprofit
- P
- Nursing home provider name
- WARREN PARK HEALTH & LIVING CTR
- Affiliation entity name
- CITADEL HEALTHCARE
- Affiliation entity id
- 147
- Address line 1
- 6700 NORTH DAMEN AVE
- City
- CHICAGO
- State
- IL
- Zip code
- 606454902