Healthcare Provider Details

I. General information

NPI: 1326032616
Provider Name (Legal Business Name): RESURRECTION SENIOR SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10500 GRAND AVE
FRANKLIN PARK IL
60131-2210
US

IV. Provider business mailing address

7435 W TALCOTT AVE PROFESSIONAL BULIDING STE 340
CHICAGO IL
60631-3707
US

V. Phone/Fax

Practice location:
  • Phone: 847-233-8001
  • Fax: 847-451-1503
Mailing address:
  • Phone: 773-594-7837
  • Fax: 773-594-8567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0018317
License Number StateIL

VIII. Authorized Official

Name: MR. TOM CAPOBIANCO
Title or Position: EXECUTIVE VICE PRESIDENT FINANCE
Credential:
Phone: 773-792-7925