Healthcare Provider Details

I. General information

NPI: 1265499354
Provider Name (Legal Business Name): PARKVIEW TERRACE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3845 OAKTON ST
SKOKIE IL
60076-3429
US

IV. Provider business mailing address

3845 OAKTON ST
SKOKIE IL
60076-3429
US

V. Phone/Fax

Practice location:
  • Phone: 847-677-0100
  • Fax: 847-679-0673
Mailing address:
  • Phone: 847-677-0100
  • Fax: 847-679-0673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1713548
License Number StateIL

VIII. Authorized Official

Name: MR. ROBERT TALBOT
Title or Position: ADMINISTRATOR
Credential:
Phone: 309-755-3466