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NPI Code Detail

MEDICARE: PRESIDENTIAL PAVILION,LLC

MEDICARE: PRESIDENTIAL PAVILION,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 Facility0045526IL

General Provider Information

NPI Number : 1184693152
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRESIDENTIAL PAVILION,LLC
Provider Business Mailing Address
First Line : 8001 S WESTERN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60620-5930
Country : US
Telephone Number : 773-436-6600
Fax Number : 773-471-1661
Provider Business Practice Location Address
First Line : 8001 S WESTERN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60620-5930
Country : US
Telephone Number : 773-436-6600
Fax Number : 773-471-1661
Authorized Official
Title or Position : CEO
Name : MR. AVRUM WEINFELD
Credential :
Telephone Number : 847-674-5795
Provider Enumeration Date : 03/14/2006
Last Update Date : 08/22/2020

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