1649341421 NPI number — FOREST VILLA NURSING AND REHABILITATION CENTER, LLC

Table of content: (NPI 1649341421)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649341421 NPI number — FOREST VILLA NURSING AND REHABILITATION CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOREST VILLA NURSING AND REHABILITATION CENTER, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AVANTI WELLNESS AND REHABILITATION
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649341421
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6840 W. TOUHY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NILES
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-647-6400
Provider Business Mailing Address Fax Number:
847-647-1539

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6840 W. TOUHY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NILES
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-647-8994
Provider Business Practice Location Address Fax Number:
847-647-0500
Provider Enumeration Date:
11/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ANDREWS
Authorized Official First Name:
AMANDA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
847-647-6400

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BN1400X , with the licence number: 5003240001 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: 5003240001 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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