Provider Demographics
NPI:1225190572
Name:EMBASSY CARE CENTER
Entity type:Organization
Organization Name:EMBASSY CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:NACHSHON
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-982-1195
Mailing Address - Street 1:555 W KAHLER RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60481-1527
Mailing Address - Country:US
Mailing Address - Phone:815-476-2200
Mailing Address - Fax:815-476-7939
Practice Address - Street 1:555 W KAHLER RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:IL
Practice Address - Zip Code:60481-1527
Practice Address - Country:US
Practice Address - Phone:815-476-2200
Practice Address - Fax:815-476-7939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1762815314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid