- Enrollment id
- O20140509000235
- Enrollment state
- IL
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1437471075
- Multiple npi flag
- N
- Ccn
- 145829
- Associate id
- 7113150558
- Organization name
- KENSINGTON PLACE NURSING AND REHABILITATION CENTER LLC
- Organization type structure
- LLC
- Proprietary nonprofit
- D
- Nursing home provider name
- KENSINGTON PLACE NRSG & REHAB
- Affiliation entity name
- WISSATI IRREVOCABLE TRUST
- Affiliation entity id
- 861
- Address line 1
- 3405 S MICHIGAN AVE
- City
- CHICAGO
- State
- IL
- Zip code
- 606163819