Healthcare Provider Details

I. General information

NPI: 1205083771
Provider Name (Legal Business Name): ARDEN COURTS OF GENEVA IL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 03/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2388 BRICHER RD
GENEVA IL
60134-3699
US

IV. Provider business mailing address

333 N SUMMIT ST ATTN BARRY A LAZARUS
TOLEDO OH
43604-1531
US

V. Phone/Fax

Practice location:
  • Phone: 630-262-3900
  • Fax: 630-262-8889
Mailing address:
  • Phone: 419-252-5541
  • Fax: 419-254-5494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. BARRY A LAZARUS
Title or Position: VICE PRESIDENT-REIMBURSEMENT
Credential:
Phone: 419-252-5541