Healthcare Provider Details

I. General information

NPI: 1568461820
Provider Name (Legal Business Name): REST HAVEN ILLIANA CHRISTIAN CONVALESCENT HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14301 INDEPENDENCE WAY
HOMER GLEN IL
60491-7210
US

IV. Provider business mailing address

14301 INDEPENDENCE WAY
HOMER GLEN IL
60491-7210
US

V. Phone/Fax

Practice location:
  • Phone: 800-509-2800
  • Fax: 708-877-4818
Mailing address:
  • Phone: 800-509-2800
  • Fax: 708-877-4818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1010138
License Number StateIL

VIII. Authorized Official

Name: JOHANNA ZANDSTRA
Title or Position: VICE PRESIDENT OF OPERATIONS
Credential:
Phone: 708-342-8100