Healthcare Provider Details

I. General information

NPI: 1386123354
Provider Name (Legal Business Name): ST CHARLES SKILLED NURSING FACILITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2018
Last Update Date: 08/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 ALLEN LN
ST CHARLES IL
60174-1355
US

IV. Provider business mailing address

3450 OAKTON ST
SKOKIE IL
60076-2951
US

V. Phone/Fax

Practice location:
  • Phone: 630-377-2211
  • Fax: 630-377-4352
Mailing address:
  • Phone: 847-679-9797
  • Fax: 847-679-1026

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: MENACHEM SHABAT
Title or Position: PRINCIPAL
Credential:
Phone: 847-679-9797