Healthcare Provider Details

I. General information

NPI: 1518954072
Provider Name (Legal Business Name): HEATHER HEALTH CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 11/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15600 HONORE AVE
HARVEY IL
60426-4102
US

IV. Provider business mailing address

4200 W PETERSON AVE SUITE 140
CHICAGO IL
60646-6074
US

V. Phone/Fax

Practice location:
  • Phone: 708-333-9550
  • Fax: 708-333-9554
Mailing address:
  • Phone: 773-286-6622
  • Fax: 773-286-2150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0023945
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: FLOYD A SCHLOSSBERG
Title or Position: PRESIDENT
Credential:
Phone: 773-286-6622