Healthcare Provider Details

I. General information

NPI: 1851378046
Provider Name (Legal Business Name): STERLING PAVILION, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 11/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E 23RD ST
STERLING IL
61081-1212
US

IV. Provider business mailing address

3359 MAIN ST
SKOKIE IL
60076-2432
US

V. Phone/Fax

Practice location:
  • Phone: 815-626-4264
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0040436
License Number StateIL

VIII. Authorized Official

Name: MR. MARSHALL A MAUER
Title or Position: SECRETARY-TREASURER
Credential:
Phone: 847-679-8219