- Enrollment id
- O20090303000105
- Enrollment state
- IL
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1679746317
- Multiple npi flag
- N
- Ccn
- 145343
- Associate id
- 6709942576
- Organization name
- AMBASSADOR NURSING AND REHABILITATION CENTER II LLC
- Incorporation date
- 2007-08-06
- Incorporation state
- IL
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- AMBASSADOR NURSING & REHAB CENTER
- Affiliation entity name
- INFINITY HEALTHCARE CONSULTING
- Affiliation entity id
- 763
- Address line 1
- 4900 N BERNARD STREET
- City
- CHICAGO
- State
- IL
- Zip code
- 606255146