Healthcare Provider Details

I. General information

NPI: 1093706277
Provider Name (Legal Business Name): AMBASSADOR NURSING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 N BERNARD ST ATTN: LEONARD WEISS
CHICAGO IL
60625-5146
US

IV. Provider business mailing address

4900 N BERNARD ST
CHICAGO IL
60625-5146
US

V. Phone/Fax

Practice location:
  • Phone: 773-583-7130
  • Fax: 773-583-3929
Mailing address:
  • Phone: 773-583-7130
  • Fax: 773-583-3929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0004077
License Number StateIL

VIII. Authorized Official

Name: LEONARD WEISS
Title or Position: CFO
Credential:
Phone: 847-674-7600