Healthcare Provider Details

I. General information

NPI: 1790861383
Provider Name (Legal Business Name): PINNACLE HEALTHCARE OF LA GRANGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N LA GRANGE RD
LA GRANGE PARK IL
60526
US

IV. Provider business mailing address

1020 N MILWAUKEE AVE SUITE 140
DEERFIELD IL
60526
US

V. Phone/Fax

Practice location:
  • Phone: 708-354-7300
  • Fax: 708-354-8928
Mailing address:
  • Phone: 847-541-9100
  • Fax: 847-541-9015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0046284
License Number StateIL

VIII. Authorized Official

Name: MRS. EDNA B BROSAS
Title or Position: MANAGER
Credential:
Phone: 847-541-9100