Healthcare Provider Details

I. General information

NPI: 1043385966
Provider Name (Legal Business Name): HALSTED TERRACE NURSING CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 09/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10935 S HALSTED ST
CHICAGO IL
60628
US

IV. Provider business mailing address

10935 S HALSTED ST
CHICAGO IL
60628
US

V. Phone/Fax

Practice location:
  • Phone: 773-928-2000
  • Fax: 773-928-9154
Mailing address:
  • Phone: 773-928-2000
  • Fax: 773-928-9154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number000020842
License Number StateIL

VIII. Authorized Official

Name: MR. JAMES T SLESUR
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CPA
Phone: 847-763-2550