Healthcare Provider Details

I. General information

NPI: 1932681814
Provider Name (Legal Business Name): GENERATIONS AT CANTON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2018
Last Update Date: 09/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2081 N MAIN ST
CANTON IL
61520-1032
US

IV. Provider business mailing address

6840 N LINCOLN AVE
LINCOLNWOOD IL
60712-2628
US

V. Phone/Fax

Practice location:
  • Phone: 309-647-6135
  • Fax:
Mailing address:
  • Phone: 847-674-5200
  • Fax: 847-675-0555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: THOMAS WINTER
Title or Position: CFO
Credential:
Phone: 847-674-5200