Healthcare Provider Details

I. General information

NPI: 1104803394
Provider Name (Legal Business Name): GILMAN NURSING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 12/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1390 S CRESCENT ROUTE 45 SOUTH
GILMAN IL
60938
US

IV. Provider business mailing address

PO BOX 597523
CHICAGO IL
60659-7523
US

V. Phone/Fax

Practice location:
  • Phone: 815-265-7208
  • Fax: 815-265-0345
Mailing address:
  • Phone: 847-831-0201
  • Fax: 847-831-0345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0044263
License Number StateIL

VIII. Authorized Official

Name: MR. MORRIS STEINBERG
Title or Position: MANAGER MEMBER LLC
Credential:
Phone: 847-831-0201