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General NPI Number Information
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NPI Number | 1962726406
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Entity Type | Organization
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Legal Business Name | S-H OPCO PROSPECT HEIGHTS, LLC
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Dates
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Enumeration Date | 03/25/2010
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Last Update Date | 03/02/2015
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Provider Practice Location Address
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Address Line | 700 E EUCLID AVE
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City | PROSPECT HEIGHTS
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State | IL
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Zip | 60070-3409
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Country | US
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Telephone | 847-797-2700
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Fax | 847-797-2705
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Provider Business Mailing Address
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Address Line | 700 E EUCLID AVE
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City | PROSPECT HEIGHTS
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State | IL
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Zip | 60070-3409
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Country | US
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Telephone | 847-797-2700
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Fax | 847-797-2705
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MARK W OHLENDORF
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Credential |
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Telephone | 414-918-5000
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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 | 0050872
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License Number State | IL
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