Healthcare Provider Details

I. General information

NPI: 1801991161
Provider Name (Legal Business Name): WHITEHALL NORTH, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 WAUKEGAN RD
DEERFIELD IL
60015-4908
US

IV. Provider business mailing address

300 WAUKEGAN RD
DEERFIELD IL
60015-4908
US

V. Phone/Fax

Practice location:
  • Phone: 847-945-4600
  • Fax:
Mailing address:
  • Phone: 847-945-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0046474
License Number StateIL

VIII. Authorized Official

Name: MR. MARK HOLLANDER
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 847-679-9141