Healthcare Provider Details

I. General information

NPI: 1255573077
Provider Name (Legal Business Name): PLUM GROVE NURSING AND REHAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2009
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 S PLUM GROVE RD
PALATINE IL
60067-6243
US

IV. Provider business mailing address

8131 MONTICELLO AVE
SKOKIE IL
60076-3325
US

V. Phone/Fax

Practice location:
  • Phone: 847-358-0311
  • Fax: 847-358-8875
Mailing address:
  • Phone: 847-673-6767
  • Fax: 847-673-6768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. YOSEF MEYSTEL
Title or Position: MANAGER
Credential:
Phone: 847-673-6767