Provider Demographics
NPI:1023042728
Name:AMBOY NURSING ACQUISITION & MANAGEMENT LLC
Entity Type:Organization
Organization Name:AMBOY NURSING ACQUISITION & MANAGEMENT LLC
Other - Org Name:AMBOY NURSING ACQUISITION & MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WESTERKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-649-1577
Mailing Address - Street 1:15 W WASSON RD
Mailing Address - Street 2:
Mailing Address - City:AMBOY
Mailing Address - State:IL
Mailing Address - Zip Code:61310
Mailing Address - Country:US
Mailing Address - Phone:815-857-2550
Mailing Address - Fax:815-857-4016
Practice Address - Street 1:15 W WASSON RD
Practice Address - Street 2:
Practice Address - City:AMBOY
Practice Address - State:IL
Practice Address - Zip Code:61310-1141
Practice Address - Country:US
Practice Address - Phone:815-857-2550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0047696314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========Medicaid
IL=========Medicaid