Healthcare Provider Details

I. General information

NPI: 1336100999
Provider Name (Legal Business Name): FLORA PAVILION NURSING HOME CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 SHADWELL AVE
FLORA IL
62839-2310
US

IV. Provider business mailing address

3856 OAKTON ST SUITE
SKOKIE IL
60076-3454
US

V. Phone/Fax

Practice location:
  • Phone: 618-662-8361
  • Fax: 618-662-2811
Mailing address:
  • Phone: 847-674-4700
  • Fax: 847-674-4733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0038760
License Number StateIL

VIII. Authorized Official

Name: MR. BRADLEY ALTER
Title or Position: CEO
Credential:
Phone: 847-674-4700