Healthcare Provider Details

I. General information

NPI: 1912904673
Provider Name (Legal Business Name): GLEN ELSTON NURSING & REHABILITATION CENTRE, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 09/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4340 N KEYSTONE AVE
CHICAGO IL
60641-2121
US

IV. Provider business mailing address

5454 FARGO AVE
SKOKIE IL
60077-3210
US

V. Phone/Fax

Practice location:
  • Phone: 773-545-8700
  • Fax: 773-545-9444
Mailing address:
  • Phone: 847-674-5454
  • Fax: 847-674-8311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number4861
License Number StateIL

VIII. Authorized Official

Name: MR. SIDNEY GLENNER
Title or Position: PRESIDENT
Credential:
Phone: 847-674-5454