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NPI Code Detail

MEDICARE: PROVIDENCE OPERATIONS, LLC

MEDICARE: PROVIDENCE OPERATIONS, LLC
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
1314000000XSkilled Nursing Facility0028605IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1184626434
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROVIDENCE OPERATIONS, LLC
Provider Business Mailing Address
First Line : 18601 NORTH CREEK DRIVE
Second Line :
City : TINLEY PARK
State : IL
Zip : 60477
Country : US
Telephone Number : 708-342-8100
Fax Number : 708-342-8006
Provider Business Practice Location Address
First Line : 3450 SARATOGA AVE
Second Line :
City : DOWNERS GROVE
State : IL
Zip : 60515-1141
Country : US
Telephone Number : 630-969-2900
Fax Number : 630-969-2900
Authorized Official
Title or Position : COMPLIANCE OFFICER
Name : MRS. JOHANNA R ZANDSTRA
Credential :
Telephone Number : 708-342-8137
Provider Enumeration Date : 06/01/2005
Last Update Date : 08/13/2015

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Directions to “PROVIDENCE OPERATIONS, LLC ” Practice Location

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