Healthcare Provider Details

I. General information

NPI: 1447068424
Provider Name (Legal Business Name): HAZEL CREST SLF, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2024
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17400 KEDZIE AVE
HAZEL CREST IL
60429-1600
US

IV. Provider business mailing address

4107 OAKTON ST
SKOKIE IL
60076-3243
US

V. Phone/Fax

Practice location:
  • Phone: 708-335-1600
  • Fax:
Mailing address:
  • Phone: 847-423-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: ELCHANAN FINESTONE
Title or Position: AUTHORIZED REPRESENTATIVE
Credential:
Phone: 847-423-0900