Basic Information
| Provider Information | |||||||||
| NPI: | 1487855581 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PARK HAVEN NURSING & REHABILITATION CENTER LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | INTEGRITY HEALTHCARE OF SMITHTON | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4213 MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600762046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7082360000 | ||||||||
| FaxNumber: | 7082360001 | ||||||||
| Practice Location | |||||||||
| Address1: | 107 SOUTH LINCOLN | ||||||||
| Address2: | |||||||||
| City: | SMITHTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622851617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182354600 | ||||||||
| FaxNumber: | 6182355829 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2007 | ||||||||
| LastUpdateDate: | 03/07/2019 | ||||||||
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| AuthorizedOfficialLastName: | BLISKO | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7084262315 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.