Healthcare Provider Details

I. General information

NPI: 1447582572
Provider Name (Legal Business Name): HR MANOR CARE HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2010
Last Update Date: 01/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 W 95TH ST
OAK LAWN IL
60453-2256
US

IV. Provider business mailing address

6300 W 95TH ST
OAK LAWN IL
60453-2256
US

V. Phone/Fax

Practice location:
  • Phone: 708-233-5116
  • Fax: 708-599-8820
Mailing address:
  • Phone: 708-233-5116
  • Fax: 708-599-8820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number160005381
License Number StateIL

VIII. Authorized Official

Name: MR. FRANK CZUBA
Title or Position: DIRECTOR OF REHAB
Credential: OTR/L
Phone: 708-233-5116