Healthcare Provider Details

I. General information

NPI: 1831567015
Provider Name (Legal Business Name): CITADEL CARE CENTER-ELGIN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2015
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 S STATE ST
ELGIN IL
60123-6429
US

IV. Provider business mailing address

3755 CHASE AVE
SKOKIE IL
60076-4008
US

V. Phone/Fax

Practice location:
  • Phone: 847-742-3310
  • Fax: 847-742-0924
Mailing address:
  • Phone: 224-470-2044
  • Fax: 224-470-2952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. JONATHON AARON
Title or Position: MANAGER
Credential:
Phone: 224-470-2044