Healthcare Provider Details

I. General information

NPI: 1033166160
Provider Name (Legal Business Name): BALLARD NURSING CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 03/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 W BALLARD RD
DES PLAINES IL
60016-4904
US

IV. Provider business mailing address

9300 W BALLARD RD
DES PLAINES IL
60016-4904
US

V. Phone/Fax

Practice location:
  • Phone: 847-294-2300
  • Fax: 847-299-4012
Mailing address:
  • Phone: 847-294-2300
  • Fax: 847-299-4012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0023093
License Number StateIL

VIII. Authorized Official

Name: MR. MARK PICK
Title or Position: VICE PRESIDENT
Credential:
Phone: 847-294-2308