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NPI Code Detail

MEDICARE: THE HAVEN ON THE RIVER, LLC

MEDICARE: THE HAVEN ON THE RIVER, 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 Facility

General Provider Information

NPI Number : 1205707676
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE HAVEN ON THE RIVER, LLC
Provider Business Mailing Address
First Line : 2201 MAIN ST
Second Line :
City : EVANSTON
State : IL
Zip : 60202-1519
Country : US
Telephone Number : 847-905-3220
Fax Number :
Provider Business Practice Location Address
First Line : 320 S 2ND ST
Second Line :
City : GRAYVILLE
State : IL
Zip : 62844-1527
Country : US
Telephone Number : 618-375-2171
Fax Number :
Authorized Official
Title or Position : CFO
Name : MR. JAMES GREGORY
Credential :
Telephone Number : 847-905-3220
Provider Enumeration Date : 09/17/2025
Last Update Date : 10/30/2025

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Directions to “THE HAVEN ON THE RIVER, LLC ” Practice Location

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