- Enrollment id
- O20090209000130
- Enrollment state
- IL
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1508029919
- Multiple npi flag
- N
- Ccn
- 145696
- Associate id
- 9234294273
- Organization name
- NILES NURSING & REHABILITATION CENTER, LLC
- Incorporation date
- 2008-05-27
- Incorporation state
- IL
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- NILES NSG & REHAB CTR
- Affiliation entity name
- INFINITY HEALTHCARE CONSULTING
- Affiliation entity id
- 763
- Address line 1
- 9777 GREENWOOD AVE
- City
- NILES
- State
- IL
- Zip code
- 607141002