Healthcare Provider Details

I. General information

NPI: 1164552873
Provider Name (Legal Business Name): PALOS HILLS EXTENDED CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 01/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10426 S ROBERTS RD
PALOS HILLS IL
60465-1932
US

IV. Provider business mailing address

10426 S ROBERTS RD
PALOS HILLS IL
60465-1932
US

V. Phone/Fax

Practice location:
  • Phone: 708-598-3460
  • Fax: 708-598-0520
Mailing address:
  • Phone: 708-598-3460
  • Fax: 708-598-0520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0046029
License Number StateIL

VIII. Authorized Official

Name: MR. ROBERT KAPLAN
Title or Position: OWNER
Credential: COMPTROLLER
Phone: 708-598-3460