Healthcare Provider Details

I. General information

NPI: 1508858994
Provider Name (Legal Business Name): GENERATIONS AT REGENCY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 04/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6631 N MILWAUKEE
NILES IL
60714-4416
US

IV. Provider business mailing address

6631 N MILWAUKEE
NILES IL
60714-4416
US

V. Phone/Fax

Practice location:
  • Phone: 847-647-7444
  • Fax: 847-647-6403
Mailing address:
  • Phone: 847-647-7444
  • Fax: 847-647-6403

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. THOMAS WINTER
Title or Position: CFO
Credential:
Phone: 847-675-7979