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NPI Code Detail

MEDICARE: PHDC, LLC

MEDICARE: PHDC, 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 : 1740582055
Entity Type Code : Organization
Provider Name (Legal Business Name) : PHDC, LLC
Provider Business Mailing Address
First Line : 7444 LONG AVE
Second Line :
City : SKOKIE
State : IL
Zip : 60077-3214
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 631 W MAIN ST
Second Line :
City : BUFFALO
State : MO
Zip : 65622-7496
Country : US
Telephone Number : 847-329-4100
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : BENJAMIN KLEIN
Credential :
Telephone Number : 847-329-4100
Provider Enumeration Date : 11/19/2010
Last Update Date : 03/25/2015

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Directions to “PHDC, LLC ” Practice Location

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