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General NPI Number Information
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NPI Number | 1730183203
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Entity Type | Organization
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Legal Business Name | BALMORAL HOME INC
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Dates
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Enumeration Date | 06/12/2005
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Last Update Date | 01/13/2022
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Provider Practice Location Address
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Address Line | 2055 W BALMORAL AVE
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City | CHICAGO
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State | IL
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Zip | 60625-1001
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Country | US
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Telephone | 773-561-8661
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Fax | 773-561-9376
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Provider Business Mailing Address
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Address Line | 6500 N HAMLIN AVE
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City | LINCOLNWOOD
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State | IL
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Zip | 60712-3904
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Country | US
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Telephone | 847-679-7484
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Fax | 847-679-7484
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. YONATHAN M STERN
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Credential |
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Telephone | 773-561-8661
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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 | 000039966
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License Number State | IL
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