Healthcare Provider Details

I. General information

NPI: 1962497982
Provider Name (Legal Business Name): DOBSON PLAZA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 11/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 DODGE AVE
EVANSTON IL
60202-3622
US

IV. Provider business mailing address

120 DODGE AVE
EVANSTON IL
60202-3622
US

V. Phone/Fax

Practice location:
  • Phone: 847-869-7744
  • Fax: 847-869-3027
Mailing address:
  • Phone: 847-869-7744
  • Fax: 847-869-3027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0008136
License Number StateIL

VIII. Authorized Official

Name: MRS. CATHY SINGER
Title or Position: ASSISTANT ADMINISTRATOR
Credential:
Phone: 847-869-7744