Healthcare Provider Details

I. General information

NPI: 1710974993
Provider Name (Legal Business Name): OAKTON PAVILLION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 12/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 OAKTON PL
DES PLAINES IL
60018-2045
US

IV. Provider business mailing address

1660 OAKTON PL
DES PLAINES IL
60018-2045
US

V. Phone/Fax

Practice location:
  • Phone: 847-299-5588
  • Fax: 847-493-6525
Mailing address:
  • Phone: 847-299-5588
  • Fax: 847-493-6525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0025056
License Number StateIL

VIII. Authorized Official

Name: MR. JAY LEWKOWITZ
Title or Position: EXECUTIVE DIRECTOR
Credential: CNHA
Phone: 847-299-5588