Healthcare Provider Details

I. General information

NPI: 1487826384
Provider Name (Legal Business Name): PHRS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2008
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

578 COMMERCIAL ST
MARSEILLES IL
61341-1814
US

IV. Provider business mailing address

7444 LONG AVE
SKOKIE IL
60077-3214
US

V. Phone/Fax

Practice location:
  • Phone: 815-795-5121
  • Fax: 815-795-6213
Mailing address:
  • Phone: 847-329-4100
  • Fax: 847-329-4900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0049528
License Number StateIL

VIII. Authorized Official

Name: MS. MARALEE RUNGEE
Title or Position: OFFICE MANAGER
Credential:
Phone: 847-329-4100