Healthcare Provider Details

I. General information

NPI: 1124343157
Provider Name (Legal Business Name): PRESBYTERIAN HOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2010
Last Update Date: 04/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 GRANT ST
EVANSTON IL
60201-1903
US

IV. Provider business mailing address

3200 GRANT ST
EVANSTON IL
60201-1903
US

V. Phone/Fax

Practice location:
  • Phone: 847-492-4800
  • Fax: 847-316-8723
Mailing address:
  • Phone: 847-492-4800
  • Fax: 847-316-8723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number0012930
License Number StateIL

VIII. Authorized Official

Name: MR. ROBERT LANDSMAN
Title or Position: VICE PRESIDENT OF FINANCE
Credential:
Phone: 847-492-4856