- Enrollment id
- O20090922000591
- Enrollment state
- IL
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1912134347
- Multiple npi flag
- N
- Ccn
- 145914
- Associate id
- 0143376863
- Organization name
- SOUTHPOINT NURSING AND REHABILITATION CENTER LLC
- Incorporation date
- 2009-02-27
- Incorporation state
- IL
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- LANDMARK AT 95TH REHABILITATION AND NURSING CENTER LLC
- Affiliation entity name
- INFINITY HEALTHCARE CONSULTING
- Affiliation entity id
- 763
- Address line 1
- 1010W 95TH ST
- City
- CHICAGO
- State
- IL
- Zip code
- 606431522