Healthcare Provider Details

I. General information

NPI: 1376706010
Provider Name (Legal Business Name): JENNINGS TERRACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 S. LASALLE STREET
AURORA IL
60505
US

IV. Provider business mailing address

275 S LASALLE STREET
AURORA IL
60505-4258
US

V. Phone/Fax

Practice location:
  • Phone: 630-879-6947
  • Fax: 630-879-6949
Mailing address:
  • Phone: 630-897-6947
  • Fax: 630-897-6949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0010371
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number0010371
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number0010371
License Number StateIL

VIII. Authorized Official

Name: JOMARIE SILVER
Title or Position: ADMINISTRATOR
Credential:
Phone: 630-235-1013