Healthcare Provider Details

I. General information

NPI: 1205266988
Provider Name (Legal Business Name): SBNB INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2013
Last Update Date: 05/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E LAKE ST
ELMHURST IL
60126-2013
US

IV. Provider business mailing address

200 E LAKE ST
ELMHURST IL
60126-2013
US

V. Phone/Fax

Practice location:
  • Phone: 630-516-5000
  • Fax:
Mailing address:
  • Phone: 630-516-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MADHUSUDAN DAVE
Title or Position: PRESIDENT
Credential:
Phone: 630-516-5000