Healthcare Provider Details

I. General information

NPI: 1831169945
Provider Name (Legal Business Name): PRESBYTERIAN HOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 PEMBRIDGE DR
LAKE FOREST IL
60045
US

IV. Provider business mailing address

3200 GRANT ST ATTN ACCOUNTING DEPARTMENT
EVANSTON IL
60201
US

V. Phone/Fax

Practice location:
  • Phone: 847-604-6700
  • Fax: 847-604-6604
Mailing address:
  • Phone: 847-492-4871
  • Fax: 847-570-3426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number0044065
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number0044065
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0044065
License Number StateIL

VIII. Authorized Official

Name: MR. ROBERT E LANDSMAN
Title or Position: VICE PRESIDENT OF FINANCE
Credential:
Phone: 847-492-4859