MEDICARE: ACCOLADE HEALTHCARE OF PAXTON SENIOR LIVING LLC

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

General Provider Information

NPI Number	:	1053823591
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCOLADE HEALTHCARE OF PAXTON SENIOR LIVING LLC

Provider Business Mailing Address
First Line	:	450 E FULTON ST
Second Line	:
City	:	PAXTON
State	:	IL
Zip	:	60957-1716
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	450 E FULTON ST
Second Line	:
City	:	PAXTON
State	:	IL
Zip	:	60957-1716
Country	:	US
Telephone Number	:	217-379-2116
Fax Number	:	217-379-3000

Authorized Official
Title or Position	:	MANAGER
Name	:	MOSHE FREEDMAN
Credential	:
Telephone Number	:	973-557-3337

Provider Enumeration Date	:	10/24/2017
Last Update Date	:	03/28/2022

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