Healthcare Provider Details

I. General information

NPI: 1053316430
Provider Name (Legal Business Name): GENERATIONS AT ELMWOOD PARK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7733 W GRAND AVE
ELMWOOD PARK IL
60707-1820
US

IV. Provider business mailing address

6840 N LINCOLN AVE
LINCOLNWOOD IL
60712-2628
US

V. Phone/Fax

Practice location:
  • Phone: 708-452-9200
  • Fax: 708-452-9294
Mailing address:
  • Phone: 847-674-5200
  • Fax: 847-674-5267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0040410
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number801
License Number StateIL

VIII. Authorized Official

Name: MR. THOMAS WINTER
Title or Position: TREASURER
Credential: CPA
Phone: 847-674-5200