Basic Information
| Provider Information | |||||||||
| NPI: | 1972602738 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GARDEN VIEW HOME, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | GARDEN VIEW NURSING & REHAB CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8320 SKOKIE BLVD | ||||||||
| Address2: | |||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600772545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8479339280 | ||||||||
| FaxNumber: | 8479339285 | ||||||||
| Practice Location | |||||||||
| Address1: | 6450 N RIDGE BLVD | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606264804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7737438700 | ||||||||
| FaxNumber: | 7737430140 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SEGALL | ||||||||
| AuthorizedOfficialFirstName: | JEREMY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ATTORNEY | ||||||||
| AuthorizedOfficialTelephone: | 8479339280 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | ESQ. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 0009035 | IL | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.