Healthcare Provider Details

I. General information

NPI: 1962726406
Provider Name (Legal Business Name): S-H OPCO PROSPECT HEIGHTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2010
Last Update Date: 03/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 E EUCLID AVE
PROSPECT HEIGHTS IL
60070-3409
US

IV. Provider business mailing address

700 E EUCLID AVE
PROSPECT HEIGHTS IL
60070-3409
US

V. Phone/Fax

Practice location:
  • Phone: 847-797-2700
  • Fax: 847-797-2705
Mailing address:
  • Phone: 847-797-2700
  • Fax: 847-797-2705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0050872
License Number StateIL

VIII. Authorized Official

Name: MR. MARK W OHLENDORF
Title or Position: PRESIDENT
Credential:
Phone: 414-918-5000