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NPI Code Detail

MEDICARE: GLEN CREST NURSING & REHABILITATION CENTRE LTD

MEDICARE: GLEN CREST NURSING & REHABILITATION CENTRE LTD
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 Facility28753IL

General Provider Information

NPI Number : 1790782456
Entity Type Code : Organization
Provider Name (Legal Business Name) : GLEN CREST NURSING & REHABILITATION CENTRE LTD
Provider Business Mailing Address
First Line : 5454 FARGO AVE
Second Line :
City : SKOKIE
State : IL
Zip : 60077-3210
Country : US
Telephone Number : 847-674-5454
Fax Number : 847-674-8311
Provider Business Practice Location Address
First Line : 2451 W TOUHY AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60645-3309
Country : US
Telephone Number : 773-338-6800
Fax Number : 773-338-1166
Authorized Official
Title or Position : PRESIDENT
Name : MR. SIDNEY GLENNER
Credential :
Telephone Number : 847-674-5454
Provider Enumeration Date : 07/07/2005
Last Update Date : 11/02/2011

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