Healthcare Provider Details

I. General information

NPI: 1548614910
Provider Name (Legal Business Name): REST HAVEN ILLIANA CHRISTIAN CONVALESCENT HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2016
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 PARK PL
SAINT JOHN IN
46373-8666
US

IV. Provider business mailing address

18601 N CREEK DR
TINLEY PARK IL
60477-6397
US

V. Phone/Fax

Practice location:
  • Phone: 800-509-2800
  • Fax: 708-342-8006
Mailing address:
  • Phone: 708-342-8100
  • Fax: 708-342-8006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JOHANNA ZANDSTRA
Title or Position: VICE PRESIDENT OF OPERATIONS
Credential:
Phone: 708-342-8100