Healthcare Provider Details

I. General information

NPI: 1073688974
Provider Name (Legal Business Name): GLENVIEW TERRACE NURSING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 10/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 GREENWOOD RD
GLENVIEW IL
60026-1513
US

IV. Provider business mailing address

1511 GREENWOOD RD
GLENVIEW IL
60026-1513
US

V. Phone/Fax

Practice location:
  • Phone: 847-729-9090
  • Fax: 847-729-9135
Mailing address:
  • Phone: 847-729-9090
  • Fax: 847-729-9135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number000026237
License Number StateIL

VIII. Authorized Official

Name: MR. JAMES T SLESUR
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CPA
Phone: 847-763-2550