- Enrollment id
- O20210816001152
- Enrollment state
- IL
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1871163030
- Multiple npi flag
- N
- Ccn
- 145776
- Associate id
- 4486059375
- Organization name
- BEACON CARE AND REHABILITATION CENTER LLC
- Doing business as name
- COMPLETE CARE AT SHERIDAN COMMONS
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- COMPLETE CARE AT SHERIDEN COMMONS
- Affiliation entity name
- COMPLETE CARE
- Affiliation entity id
- 157
- Address line 1
- 4538 N BEACON ST
- City
- CHICAGO
- State
- IL
- Zip code
- 606405519