Healthcare Provider Details

I. General information

NPI: 1699703074
Provider Name (Legal Business Name): SHARON HEALTH CARE PINES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 07/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3614 N ROCHELLE
PEORIA IL
61604-1039
US

IV. Provider business mailing address

465 CENTRAL AVE SUITE 100
NORTHFIELD IL
60093-3045
US

V. Phone/Fax

Practice location:
  • Phone: 309-688-0350
  • Fax: 847-688-4564
Mailing address:
  • Phone: 847-441-8200
  • Fax: 847-441-0800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number1719828
License Number StateIL

VIII. Authorized Official

Name: RICHARD DEAN DUROS
Title or Position: CFO COO
Credential:
Phone: 847-441-8200