Healthcare Provider Details

I. General information

NPI: 1205625654
Provider Name (Legal Business Name): PRIME HEALTHCARE SENIOR LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2025
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 N GREENWOOD AVE
PARK RIDGE IL
60068-2054
US

IV. Provider business mailing address

1001 N GREENWOOD AVE
PARK RIDGE IL
60068-2054
US

V. Phone/Fax

Practice location:
  • Phone: 847-692-5600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER DOAN
Title or Position: MANAGING ASSOCIATE GENERAL COUNSEL
Credential:
Phone: 310-259-4706