- Enrollment id
- O20200218000244
- Enrollment state
- IL
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1801432711
- Multiple npi flag
- N
- Ccn
- 145482
- Associate id
- 0143657908
- Organization name
- SHERIDAN VILLAGE NURSING AND REHABILITATION CENTER LLC
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- SHERIDAN VILLAGE NRSG & RHB
- Affiliation entity name
- ATIED ASSOCIATES
- Affiliation entity id
- 53
- Address line 1
- 5838 N SHERIDAN RD
- City
- CHICAGO
- State
- IL
- Zip code
- 606604916