- Enrollment id
- O20220929000219
- Enrollment state
- IL
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1386364487
- Multiple npi flag
- N
- Ccn
- 145706
- Associate id
- 1153707195
- Organization name
- WHITEHALL SKILLED NURSING FACILITY LLC
- Doing business as name
- WHITEHALL OF DEERFIELD
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- WHITEHALL OF DEERFIELD
- Affiliation entity name
- LEGACY HEALTHCARE
- Affiliation entity id
- 306
- Address line 1
- 300 WAUKEGAN RD
- City
- DEERFIELD
- State
- IL
- Zip code
- 600154908