1154325892 NPI number — HILLCREST RETIREMENT VILLAGE LTD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154325892 NPI number — HILLCREST RETIREMENT VILLAGE LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HILLCREST RETIREMENT VILLAGE LTD
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:
HILLCREST NURSING CENTER
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:
1154325892
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1740 NORTH CIRCUIT DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROUND LAKE BEACH
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60073
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-546-5300
Provider Business Mailing Address Fax Number:
847-546-7563

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1740 CIRCUIT DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROUND LAKE BEACH
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60073-3803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-546-5300
Provider Business Practice Location Address Fax Number:
847-546-7563
Provider Enumeration Date:
06/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ROSENBAUM
Authorized Official First Name:
ALAN
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
847-546-5300

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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