Healthcare Provider Details

I. General information

NPI: 1689096745
Provider Name (Legal Business Name): PARC AT JOLIET LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2014
Last Update Date: 01/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 N HAMMES AVE
JOLIET IL
60435-8161
US

IV. Provider business mailing address

2201 MAIN ST
EVANSTON IL
60202-1519
US

V. Phone/Fax

Practice location:
  • Phone: 815-725-0443
  • Fax:
Mailing address:
  • Phone: 847-905-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0052571
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number0052571
License Number StateIL

VIII. Authorized Official

Name: MR. CHARLES SLAGLE
Title or Position: OWNER
Credential:
Phone: 847-905-3000