MEDICARE: HILLCREST RETIREMENT VILLAGE LTD

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	:	1154325892
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HILLCREST RETIREMENT VILLAGE LTD

Provider Business Mailing Address
First Line	:	1740 NORTH CIRCUIT DRIVE
Second Line	:
City	:	ROUND LAKE BEACH
State	:	IL
Zip	:	60073
Country	:	US
Telephone Number	:	847-546-5300
Fax Number	:	847-546-7563

Provider Business Practice Location Address
First Line	:	1740 CIRCUIT DR
Second Line	:
City	:	ROUND LAKE BEACH
State	:	IL
Zip	:	60073-3803
Country	:	US
Telephone Number	:	847-546-5300
Fax Number	:	847-546-7563

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. ALAN ROSENBAUM
Credential	:
Telephone Number	:	847-546-5300

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	10/08/2021

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