Healthcare Provider Details

I. General information

NPI: 1639425697
Provider Name (Legal Business Name): MARIANJOY AT PARK PLACE CHRISTIAN COMMUNITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2012
Last Update Date: 04/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 S EUCLID AVE
ELMHURST IL
60126-5178
US

IV. Provider business mailing address

1150 S EUCLID AVE
ELMHURST IL
60126-5178
US

V. Phone/Fax

Practice location:
  • Phone: 630-909-7378
  • Fax: 630-909-7371
Mailing address:
  • Phone: 630-909-7378
  • Fax: 630-909-7371

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: MS. JACQUE' BARNES
Title or Position: PFS MANAGER
Credential:
Phone: 630-909-7378