MEDICARE: SENECA NURSING HOME, INC.

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	314000000X	Skilled Nursing Facility	0024356	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	50395	OTHER		BLUECROSS BLUESHIELD - IL

General Provider Information

NPI Number	:	1700867033
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENECA NURSING HOME, INC.

Provider Business Mailing Address
First Line	:	1301 LEE ST
Second Line	:
City	:	DES PLAINES
State	:	IL
Zip	:	60018-1514
Country	:	US
Telephone Number	:	847-635-4000
Fax Number	:	847-635-5016

Provider Business Practice Location Address
First Line	:	1301 LEE ST
Second Line	:
City	:	DES PLAINES
State	:	IL
Zip	:	60018-1514
Country	:	US
Telephone Number	:	847-635-4000
Fax Number	:	847-635-5016

Authorized Official
Title or Position	:	OWNER
Name	:	MR. CHESTER PLODZIEN
Credential	:
Telephone Number	:	847-635-4000

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	02/09/2012

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Directions to “SENECA NURSING HOME, INC. ” Practice Location

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