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General NPI Number Information
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NPI Number | 1881681245
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Entity Type | Organization
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Legal Business Name | BLOOMINGDALE PAVILION, LLC
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Dates
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Enumeration Date | 09/30/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 311 EDGEWATER DR
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-1979
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Country | US
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Telephone | 630-894-7400
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Fax | 630-894-8528
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Provider Business Mailing Address
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Address Line | 311 EDGEWATER DR
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-1979
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Country | US
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Telephone | 630-894-7400
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Fax | 630-894-8528
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Authorized Official
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Title or Position | MDS/CARE PLAN COORDINATOR
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Name | MRS. JOSEPHINE SOLIS
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Credential | L.P.N.
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Telephone | 630-894-7400
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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 | 44347
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License Number State | IL
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