Healthcare Provider Details

I. General information

NPI: 1306076484
Provider Name (Legal Business Name): THE MATHER EVANSTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2009
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 DAVIS ST
EVANSTON IL
60201-4693
US

IV. Provider business mailing address

425 DAVIS ST
EVANSTON IL
60201-4693
US

V. Phone/Fax

Practice location:
  • Phone: 847-492-7500
  • Fax:
Mailing address:
  • Phone: 847-492-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberLC 03-08
License Number StateIL

VIII. Authorized Official

Name: MARY G. LEARY
Title or Position: PRESIDENT/CEO
Credential:
Phone: 847-492-7715