MEDICARE: ELMHURST EXTENDED CARE CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	1636066	IL

General Provider Information

NPI Number	:	1023003092
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELMHURST EXTENDED CARE CENTER

Provider Business Mailing Address
First Line	:	200 E LAKE ST
Second Line	:
City	:	ELMHURST
State	:	IL
Zip	:	60126-2013
Country	:	US
Telephone Number	:	630-834-4337
Fax Number	:	630-834-0480

Provider Business Practice Location Address
First Line	:	200 E LAKE ST
Second Line	:
City	:	ELMHURST
State	:	IL
Zip	:	60126-2013
Country	:	US
Telephone Number	:	630-834-4337
Fax Number	:	630-834-0480

Authorized Official
Title or Position	:	ADMINSTRATOR
Name	:	JOHN MASSARD
Credential	:	LNHA
Telephone Number	:	630-834-4337

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	01/18/2008

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