Healthcare Provider Details

I. General information

NPI: 1730790817
Provider Name (Legal Business Name): IH FOX VALLEY OPCO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2020
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4020 E NEW YORK ST
AURORA IL
60504-4416
US

IV. Provider business mailing address

5 REVERE DR STE 200
NORTHBROOK IL
60062-8000
US

V. Phone/Fax

Practice location:
  • Phone: 331-301-5590
  • Fax:
Mailing address:
  • Phone: 312-982-1717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: BRADLEY S HABER
Title or Position: MEMBER
Credential:
Phone: 331-301-5590