Healthcare Provider Details

I. General information

NPI: 1992104780
Provider Name (Legal Business Name): GENERATIONS AT OAKTON PAVILLION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2014
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
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:
Mailing address:
  • Phone: 847-299-5588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS WINTER
Title or Position: CFO
Credential:
Phone: 847-675-7979