Healthcare Provider Details

I. General information

NPI: 1740276120
Provider Name (Legal Business Name): NORRIDGE NURSING CENTRE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 W CULLOM AVE
NORRIDGE IL
60706-7100
US

IV. Provider business mailing address

7001 W CULLOM AVE
NORRIDGE IL
60706-7100
US

V. Phone/Fax

Practice location:
  • Phone: 708-457-0700
  • Fax: 708-457-8852
Mailing address:
  • Phone: 708-457-0700
  • Fax: 708-457-8852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. CHRISTOPHER VICERE
Title or Position: V.P. FINANCE
Credential:
Phone: 773-604-4416