Healthcare Provider Details

I. General information

NPI: 1932497625
Provider Name (Legal Business Name): PRESENCE SENIOR SERVICES CHICAGOLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2011
Last Update Date: 09/10/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N RIVER RD
DES PLAINES IL
60016-1211
US

IV. Provider business mailing address

300 N RIVER RD
DES PLAINES IL
60016-1211
US

V. Phone/Fax

Practice location:
  • Phone: 847-297-5900
  • Fax:
Mailing address:
  • Phone: 847-297-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2039876
License Number StateIL

VIII. Authorized Official

Name: MICHAEL GORDON
Title or Position: CFO
Credential:
Phone: 708-478-7911