Healthcare Provider Details

I. General information

NPI: 1225022510
Provider Name (Legal Business Name): PRESENCE SENIOR SERVICES CHICAGOLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 05/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 EAST LAKE AVE
GLENVIEW IL
60025
US

IV. Provider business mailing address

1700 E LAKE AVE
GLENVIEW IL
60025-2003
US

V. Phone/Fax

Practice location:
  • Phone: 847-729-1300
  • Fax: 847-729-9620
Mailing address:
  • Phone: 847-729-1300
  • Fax: 847-729-9620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0044768
License Number StateIL

VIII. Authorized Official

Name: MICHAEL GORDON
Title or Position: CFO
Credential:
Phone: 708-478-7911