Healthcare Provider Details

I. General information

NPI: 1912771858
Provider Name (Legal Business Name): PEARL OF ST. CHARLES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2023
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 DUNHAM RD
ST CHARLES IL
60174-1494
US

IV. Provider business mailing address

6865 N LINCOLN AVE
LINCOLNWOOD IL
60712-4611
US

V. Phone/Fax

Practice location:
  • Phone: 630-443-6146
  • Fax:
Mailing address:
  • Phone:
  • 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: EITAN ZEFFREN
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 630-443-6146