Healthcare Provider Details

I. General information

NPI: 1679746317
Provider Name (Legal Business Name): AMBASSADOR NURSING AND REHABILITATION CENTER II LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 N BERNARD ST
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 Number
License Number State

VIII. Authorized Official

Name: MR. MOISHE GUBIN
Title or Position: OWNER, CFO
Credential:
Phone: 219-661-8590