Healthcare Provider Details

I. General information

NPI: 1295711471
Provider Name (Legal Business Name): CLARIDGE OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 JENKISSON AVE
LAKE BLUFF IL
60044-1618
US

IV. Provider business mailing address

700 JENKISSON
LAKE BLUFF IL
60044
US

V. Phone/Fax

Practice location:
  • Phone: 847-295-3900
  • Fax: 847-295-3989
Mailing address:
  • Phone: 847-295-3900
  • Fax: 847-283-0857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0047241
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateIL

VIII. Authorized Official

Name: MR. RICHARD SCOTT OBRIEN
Title or Position: ADMINISTRATOR
Credential:
Phone: 847-295-3900