Healthcare Provider Details

I. General information

NPI: 1700867033
Provider Name (Legal Business Name): SENECA NURSING HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 02/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 LEE ST
DES PLAINES IL
60018-1514
US

IV. Provider business mailing address

1301 LEE ST
DES PLAINES IL
60018-1514
US

V. Phone/Fax

Practice location:
  • Phone: 847-635-4000
  • Fax: 847-635-5016
Mailing address:
  • Phone: 847-635-4000
  • Fax: 847-635-5016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0024356
License Number StateIL

VIII. Authorized Official

Name: MR. CHESTER PLODZIEN
Title or Position: OWNER
Credential:
Phone: 847-635-4000