- Enrollment id
- O20050916000289
- Enrollment state
- IL
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1740256155
- Multiple npi flag
- N
- Ccn
- 145778
- Associate id
- 5799718060
- Organization name
- MIDWAY NEUROLOGICAL AND REHABILITATION CENTER LLC
- Incorporation date
- 2004-12-16
- Incorporation state
- IL
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- MIDWAY NEUROLOGICAL / REHAB CENTER
- Affiliation entity name
- INFINITY HEALTHCARE CONSULTING
- Affiliation entity id
- 763
- Address line 1
- 8540 S HARLEM AVE
- City
- BRIDGEVIEW
- State
- IL
- Zip code
- 604551778