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General NPI Number Information
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NPI Number | 1649588260
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Entity Type | Organization
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Legal Business Name | CHURCH STREET STATION SKILLED NURSING AND LIVING CENTER, LLC
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Dates
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Enumeration Date | 09/16/2010
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Last Update Date | 09/16/2010
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Provider Practice Location Address
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Address Line | 2000 W. LAKE ST.
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City | HANOVER PARK
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State | IL
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Zip | 60133
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Country | US
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Telephone | 630-556-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 7257 N LINCOLN AVE
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City | LINCOLNWOOD
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State | IL
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Zip | 60712-1810
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Country | US
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Telephone | 847-745-6226
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Fax | 847-556-0446
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Authorized Official
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Title or Position | CFO
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Name | MR. JAY FLATT
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Credential |
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Telephone | 847-745-6224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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