Healthcare Provider Details

I. General information

NPI: 1730183203
Provider Name (Legal Business Name): BALMORAL HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2005
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 W BALMORAL AVE
CHICAGO IL
60625-1001
US

IV. Provider business mailing address

6500 N HAMLIN AVE
LINCOLNWOOD IL
60712-3904
US

V. Phone/Fax

Practice location:
  • Phone: 773-561-8661
  • Fax: 773-561-9376
Mailing address:
  • Phone: 847-679-7484
  • Fax: 847-679-7484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number000039966
License Number StateIL

VIII. Authorized Official

Name: MR. YONATHAN M STERN
Title or Position: ADMINISTRATOR
Credential:
Phone: 773-561-8661