Healthcare Provider Details

I. General information

NPI: 1548374465
Provider Name (Legal Business Name): GLEN RIDGE ASSOCIATES II LIMITED PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 GLENVIEW ROAD
GLENVIEW IL
60025
US

IV. Provider business mailing address

3901 GLENVIEW ROAD
GLENVIEW IL
60025
US

V. Phone/Fax

Practice location:
  • Phone: 847-729-0000
  • Fax: 847-729-1552
Mailing address:
  • Phone: 847-729-0000
  • Fax: 847-729-1552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. FELIPE DELEON JR.
Title or Position: ADMINISTRATOR
Credential: NURSING HOME ADM RN
Phone: 847-729-0000