Healthcare Provider Details

I. General information

NPI: 1447425905
Provider Name (Legal Business Name): PALOS HILLS EXTENDED CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2008
Last Update Date: 04/25/2008
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

642 ANTHONY TRL
NORTHBROOK IL
60062-2540
US

V. Phone/Fax

Practice location:
  • Phone: 847-504-1234
  • Fax:
Mailing address:
  • Phone: 847-504-1234
  • Fax: 847-504-1203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number145650
License Number StateIL

VIII. Authorized Official

Name: ROBERT KAPLAN
Title or Position: MANAGER
Credential:
Phone: 847-504-1234