Healthcare Provider Details

I. General information

NPI: 1457746083
Provider Name (Legal Business Name): PAXTON HEALTHCARE AND REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 03/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3856 OAKTON ST STE 200
SKOKIE IL
60076-3455
US

IV. Provider business mailing address

1240 N MARKET ST
PAXTON IL
60957-4158
US

V. Phone/Fax

Practice location:
  • Phone: 847-674-4700
  • Fax: 847-674-4733
Mailing address:
  • Phone: 217-379-4896
  • Fax: 217-379-2561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2192487
License Number StateIL

VIII. Authorized Official

Name: MR. JERRY STANLEY JANUSZEWSKI
Title or Position: CFO
Credential:
Phone: 847-674-4700