Healthcare Provider Details

I. General information

NPI: 1861499790
Provider Name (Legal Business Name): GLENBRIDGE NURSING & REHABILITATION CENTER LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 11/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8333 W GOLF RD
NILES IL
60714-1113
US

IV. Provider business mailing address

5454 FARGO AVE
SKOKIE IL
60077-3210
US

V. Phone/Fax

Practice location:
  • Phone: 847-966-9190
  • Fax: 847-966-4455
Mailing address:
  • Phone: 847-674-5454
  • Fax: 847-674-8311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number35014
License Number StateIL

VIII. Authorized Official

Name: MR. SIDNEY GLENNER
Title or Position: PRESIDENT
Credential:
Phone: 847-674-5454