Healthcare Provider Details

I. General information

NPI: 1023002326
Provider Name (Legal Business Name): RESURRECTION SENIOR SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2380 E DEMPSTER ST
DES PLAINES IL
60016-4839
US

IV. Provider business mailing address

100 N RIVER RD FINANCE DIVISION, 2ND FLOOR
DES PLAINES IL
60016-1209
US

V. Phone/Fax

Practice location:
  • Phone: 847-296-3335
  • Fax: 847-296-2659
Mailing address:
  • Phone: 847-813-3722
  • Fax: 847-813-3785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0026286
License Number StateIL

VIII. Authorized Official

Name: MR. TOM CAPOBIANCO
Title or Position: EXECUTIVE VICE PRESIDENT FINANCE
Credential:
Phone: 847-813-3707