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NPI Code Detail

MEDICARE: REST HAVEN ILLIANA CHRISTIAN CONVALESCENT HOME

MEDICARE: REST HAVEN ILLIANA CHRISTIAN CONVALESCENT HOME
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251E00000XHome Health Agency003435IN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
250070OTHERINBC/BS PREFERRED PROVIDER

General Provider Information

NPI Number : 1003815275
Entity Type Code : Organization
Provider Name (Legal Business Name) : REST HAVEN ILLIANA CHRISTIAN CONVALESCENT HOME
Provider Business Mailing Address
First Line : 18601 N CREEK DR
Second Line :
City : TINLEY PARK
State : IL
Zip : 60477-6397
Country : US
Telephone Number : 708-342-8100
Fax Number : 708-342-8006
Provider Business Practice Location Address
First Line : 10700 PARK PL
Second Line :
City : SAINT JOHN
State : IN
Zip : 46373-8666
Country : US
Telephone Number : 800-509-2800
Fax Number : 219-365-3524
Authorized Official
Title or Position : VICE PRESIDENT OF OPERATIONS
Name : JOHANNA ZANDSTRA
Credential :
Telephone Number : 708-342-8100
Provider Enumeration Date : 07/19/2005
Last Update Date : 01/24/2024

Similar Medicare Providers

1790161834 — KALLI LETZ
Practice Location Address:
10700 PARK PL
SAINT JOHN, IN
46373-8666
Practice Phone: 219-351-5200
Practice Fax:
1548614910 — REST HAVEN ILLIANA CHRISTIAN CONVALESCENT HOME
Practice Location Address:
10700 PARK PL
SAINT JOHN, IN
46373-8666
Practice Phone: 800-509-2800
Practice Fax: 708-342-8006
1891211058 — JENNA STARR FLECK AGPCNP-BC
Practice Location Address:
10700 PARK PL
SAINT JOHN, IN
46373-8666
Practice Phone: 800-509-2800
Practice Fax: 219-365-3524
1336884998 — JILLIAN MARZEL WALSH
Practice Location Address:
10700 PARK PL
SAINT JOHN, IN
46373-8666
Practice Phone: 219-247-6459
Practice Fax:
1144966367 — KELLI DRISCOLL
Practice Location Address:
10700 PARK PL
SAINT JOHN, IN
46373-8666
Practice Phone: 219-247-6459
Practice Fax:
1619970860 — TOWN OF ST. JOHN
Practice Location Address:
10955 W 93RD AVE
SAINT JOHN, IN
46373-8824
Practice Phone: 219-365-6034
Practice Fax: 219-558-2080

Directions to “REST HAVEN ILLIANA CHRISTIAN CONVALESCENT HOME ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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