Healthcare Provider Details

I. General information

NPI: 1255633012
Provider Name (Legal Business Name): PARK VILLA NURSING AND REHABILITATION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2010
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12550 S RIDGELAND AVE
PALOS HEIGHTS IL
60463-1859
US

IV. Provider business mailing address

7040 N RIDGEWAY AVE
LINCOLNWOOD IL
60712-2620
US

V. Phone/Fax

Practice location:
  • Phone: 708-597-9300
  • Fax:
Mailing address:
  • Phone: 847-679-9797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1980551
License Number StateIL

VIII. Authorized Official

Name: MENACHEM BERGER
Title or Position: MANAGER
Credential:
Phone: 847-440-2660