MEDICARE: THORNTON HEIGHTS TERRACE LTD

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
1	310500000X	Mental Illness Intermediate Care Facility	1694607	IL

General Provider Information

NPI Number	:	1073541447
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THORNTON HEIGHTS TERRACE LTD

Provider Business Mailing Address
First Line	:	465 CENTRAL AVE
Second Line	:	SUITE 100
City	:	NORTHFIELD
State	:	IL
Zip	:	60093-3045
Country	:	US
Telephone Number	:	847-441-8200
Fax Number	:	847-441-0800

Provider Business Practice Location Address
First Line	:	160 WEST 10TH STREET
Second Line	:
City	:	CHICAGO HEIGHTS
State	:	IL
Zip	:	60411-2002
Country	:	US
Telephone Number	:	708-754-2220
Fax Number	:	708-754-9311

Authorized Official
Title or Position	:	CFO COO
Name	:	RICHARD DEAN DUROS
Credential	:
Telephone Number	:	847-441-8200

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	07/25/2016

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