- Enrollment id
- O20171003006555
- Enrollment state
- IL
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1609396167
- Multiple npi flag
- N
- Ccn
- 146018
- Associate id
- 9931474863
- Organization name
- LITTLE VILLAGE NURSING AND REHABILITATION CENTER, LLC
- Incorporation date
- 2017-06-12
- Incorporation state
- IL
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- LITTLE VILLAGE NRSG & RHB CTR
- Address line 1
- 2320 S LAWNDALE AVE
- City
- CHICAGO
- State
- IL
- Zip code
- 606233154