Healthcare Provider Details

I. General information

NPI: 1073714341
Provider Name (Legal Business Name): ARBOUR HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1512 W FARGO AVE
CHICAGO IL
60626-1805
US

IV. Provider business mailing address

1512 W FARGO AVE
CHICAGO IL
60626-1805
US

V. Phone/Fax

Practice location:
  • Phone: 773-465-7751
  • Fax: 773-465-2104
Mailing address:
  • Phone: 773-465-7751
  • Fax: 773-465-2104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number21767
License Number StateIL

VIII. Authorized Official

Name: DEBRA L PATTY
Title or Position: ADMINISTRATOR
Credential:
Phone: 773-465-7751