Healthcare Provider Details

I. General information

NPI: 1649341421
Provider Name (Legal Business Name): FOREST VILLA NURSING AND REHABILITATION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 12/12/2019
Certification Date: 12/12/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6840 W. TOUHY AVE
NILES IL
60714
US

IV. Provider business mailing address

6840 W. TOUHY AVE
NILES IL
60714
US

V. Phone/Fax

Practice location:
  • Phone: 847-647-8994
  • Fax: 847-647-0500
Mailing address:
  • Phone: 847-647-6400
  • Fax: 847-647-1539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number5003240001
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number5003240001
License Number StateIL

VIII. Authorized Official

Name: MS. AMANDA ANDREWS
Title or Position: ADMINISTRATOR
Credential: LNHA
Phone: 847-647-6400