Healthcare Provider Details

I. General information

NPI: 1306397427
Provider Name (Legal Business Name): SHARON HEALTHCARE WILLOWS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 CENTRAL AVE
NORTHFIELD IL
60093-3045
US

IV. Provider business mailing address

3520 N ROCHELLE LN
PEORIA IL
61604-1037
US

V. Phone/Fax

Practice location:
  • Phone: 847-441-8200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0032797
License Number StateIL

VIII. Authorized Official

Name: ELISA J. SHLOFROCK
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 847-441-8200