Healthcare Provider Details

I. General information

NPI: 1992524037
Provider Name (Legal Business Name): HAVEN OF FARMER CITY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 BROOKVIEW DR
FARMER CITY IL
61842-9746
US

IV. Provider business mailing address

2201 MAIN ST
EVANSTON IL
60202-1519
US

V. Phone/Fax

Practice location:
  • Phone: 309-928-2118
  • Fax:
Mailing address:
  • Phone: 847-905-3220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. LEVI ISRAEL
Title or Position: CEO
Credential:
Phone: 847-905-3000