Healthcare Provider Details

I. General information

NPI: 1669816633
Provider Name (Legal Business Name): THE VILLA AT SOUTH HOLLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2013
Last Update Date: 04/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 SHAFER CT SUITE 700
ROSEMONT IL
60018-4914
US

IV. Provider business mailing address

16300 WAUSAU AVE
SOUTH HOLLAND IL
60473-2158
US

V. Phone/Fax

Practice location:
  • Phone: 847-825-5386
  • Fax:
Mailing address:
  • Phone: 708-596-5500
  • 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: BENJAMIN ISRAEL
Title or Position: DIRECTOR
Credential:
Phone: 847-692-1152