Healthcare Provider Details

I. General information

NPI: 1376539767
Provider Name (Legal Business Name): OAK BROOK HEALTHCARE CENTRE, LTD.
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

2013 MIDWEST RD
OAK BROOK IL
60523-1312
US

IV. Provider business mailing address

2013 MIDWEST RD
OAK BROOK IL
60523-1312
US

V. Phone/Fax

Practice location:
  • Phone: 630-495-0220
  • Fax: 630-629-5760
Mailing address:
  • Phone: 630-495-0220
  • Fax: 630-629-5760

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