Healthcare Provider Details

I. General information

NPI: 1114903754
Provider Name (Legal Business Name): SLOVAK AMERICAN CHARITABLE ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 08/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3615 16TH ST
ZION IL
60099-1423
US

IV. Provider business mailing address

3615 16TH ST
ZION IL
60099-1423
US

V. Phone/Fax

Practice location:
  • Phone: 847-746-8382
  • Fax: 847-746-3534
Mailing address:
  • Phone: 847-746-8382
  • Fax: 847-746-3534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0025239
License Number StateIL

VIII. Authorized Official

Name: MR. JAMES STEVEN STEFO
Title or Position: EXECUTIVE DIRECTOR
Credential: CPA
Phone: 847-746-2147