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General NPI Number Information
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NPI Number | 1093706277
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Entity Type | Organization
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Legal Business Name | AMBASSADOR NURSING CENTER
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Dates
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Enumeration Date | 11/04/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4900 N BERNARD ST ATTN: LEONARD WEISS
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City | CHICAGO
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State | IL
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Zip | 60625-5146
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Country | US
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Telephone | 773-583-7130
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Fax | 773-583-3929
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Provider Business Mailing Address
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Address Line | 4900 N BERNARD ST
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City | CHICAGO
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State | IL
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Zip | 60625-5146
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Country | US
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Telephone | 773-583-7130
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Fax | 773-583-3929
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Authorized Official
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Title or Position | CFO
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Name | LEONARD WEISS
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Credential |
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Telephone | 847-674-7600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 0004077
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License Number State | IL
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