Healthcare Provider Details

I. General information

NPI: 1356729123
Provider Name (Legal Business Name): SYMPHONY HANOVER PARK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2015
Last Update Date: 09/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W LAKE ST
HANOVER PARK IL
60133-4302
US

IV. Provider business mailing address

7257 N LINCOLN AVE
LINCOLNWOOD IL
60712-1810
US

V. Phone/Fax

Practice location:
  • Phone: 630-556-2000
  • Fax:
Mailing address:
  • Phone: 847-745-6212
  • Fax:

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: DAVID HARTMAN
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 847-745-6212