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General NPI Number Information
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NPI Number | 1962225458
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Entity Type | Organization
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Legal Business Name | SHELBYVILLE HEALTHCARE & SENIOR LIVING LLC
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Dates
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Enumeration Date | 11/04/2024
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Last Update Date | 03/21/2025
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Provider Practice Location Address
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Address Line | 2116 W SOUTH 3RD ST
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City | SHELBYVILLE
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State | IL
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Zip | 62565-9102
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Country | US
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Telephone | 217-774-2128
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Fax |
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Provider Business Mailing Address
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Address Line | 8153 LAWNDALE AVE
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City | SKOKIE
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State | IL
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Zip | 60076-3321
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | KEVIN CHANKIN
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Credential |
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Telephone | 773-745-1107
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number |
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License Number State |
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Taxonomy #2
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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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