- Enrollment id
- O20131028001904
- Enrollment state
- IL
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1760823116
- Multiple npi flag
- N
- Ccn
- 145336
- Associate id
- 6305071366
- Organization name
- WARREN BARR LIVING & REHAB CENTER, LLC
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- WARREN BARR GOLD COAST
- Affiliation entity name
- LEGACY HEALTHCARE
- Affiliation entity id
- 306
- Address line 1
- 66 W OAK ST
- City
- CHICAGO
- State
- IL
- Zip code
- 606107325