Healthcare Provider Details

I. General information

NPI: 1891011615
Provider Name (Legal Business Name): GROVE OF EVANSTON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2010
Last Update Date: 04/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 ASBURY AVE
EVANSTON IL
60202-2724
US

IV. Provider business mailing address

500 ASBURY AVE
EVANSTON IL
60202-2724
US

V. Phone/Fax

Practice location:
  • Phone: 847-316-3320
  • Fax: 847-316-3337
Mailing address:
  • Phone: 847-316-3320
  • Fax: 847-316-3337

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: MRS. MARIA HAIGHT
Title or Position: MANAGER
Credential:
Phone: 847-679-9797