Healthcare Provider Details

I. General information

NPI: 1508029919
Provider Name (Legal Business Name): NILES NURSING & REHABILITATION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 07/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9777 N GREENWOOD AVE
NILES IL
60714-1002
US

IV. Provider business mailing address

9777 N GREENWOOD AVE
NILES IL
60714-1002
US

V. Phone/Fax

Practice location:
  • Phone: 847-967-7000
  • Fax: 847-967-5054
Mailing address:
  • Phone: 847-967-7000
  • Fax: 847-967-5054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL BLISKO
Title or Position: COO
Credential:
Phone: 815-791-7859