- Enrollment id
- O20171218001695
- Enrollment state
- IL
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1497268783
- Multiple npi flag
- N
- Ccn
- 146054
- Associate id
- 0941568182
- Organization name
- GALLATIN MANOR LLC
- Incorporation date
- 2017-10-18
- Incorporation state
- NY
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- GALLATIN MANOR
- Affiliation entity name
- STERN CONSULTANTS
- Affiliation entity id
- 661
- Address line 1
- 900 W RACE ST
- City
- RIDGWAY
- State
- IL
- Zip code
- 629791150