Basic Information
| Provider Information | |||||||||
| NPI: | 1548257454 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ARBOUR HEALTH CARE CENTER LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3737 W ARTHUR AVE | ||||||||
| Address2: | |||||||||
| City: | LINCOLNWOOD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 607124029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476792121 | ||||||||
| FaxNumber: | 7734652104 | ||||||||
| Practice Location | |||||||||
| Address1: | 1512 W FARGO AVE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606261805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7734657751 | ||||||||
| FaxNumber: | 7734652104 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2005 | ||||||||
| LastUpdateDate: | 12/18/2008 | ||||||||
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| AuthorizedOfficialLastName: | PATTY | ||||||||
| AuthorizedOfficialFirstName: | DEBRA | ||||||||
| AuthorizedOfficialMiddleName: | LYDIA | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7734657751 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | L.N.H.A. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 0034736 | IL | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.