Healthcare Provider Details

I. General information

NPI: 1750526232
Provider Name (Legal Business Name): TRILOGY HEALTHCARE OF WILL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2008
Last Update Date: 11/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 E RICHTON RD
CRETE IL
60417-1623
US

IV. Provider business mailing address

1251 E RICHTON RD
CRETE IL
60417-1623
US

V. Phone/Fax

Practice location:
  • Phone: 708-672-6700
  • Fax: 708-367-4405
Mailing address:
  • Phone: 708-672-6700
  • Fax: 708-367-4405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1870437
License Number StateIL

VIII. Authorized Official

Name: MR. PAUL P PLEVYAK JR.
Title or Position: SVP - FINANCE
Credential:
Phone: 502-213-1710