Healthcare Provider Details

I. General information

NPI: 1790782449
Provider Name (Legal Business Name): GLEN OAKS NURSING & REHABILITATION CENTER, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 11/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 SKOKIE BLVD
NORTHBROOK IL
60062-1612
US

IV. Provider business mailing address

5454 FARGO AVE
SKOKIE IL
60077-3210
US

V. Phone/Fax

Practice location:
  • Phone: 847-498-9320
  • Fax: 847-498-2990
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 Number22111
License Number StateIL

VIII. Authorized Official

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