1568461820 NPI number — REST HAVEN ILLIANA CHRISTIAN CONVALESCENT HOME

Table of content: (NPI 1568461820)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568461820 NPI number — REST HAVEN ILLIANA CHRISTIAN CONVALESCENT HOME

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REST HAVEN ILLIANA CHRISTIAN CONVALESCENT HOME
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:
Provider Other Organization Name Type Code:
6
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:
1568461820
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14301 INDEPENDENCE WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOMER GLEN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60491-7210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-509-2800
Provider Business Mailing Address Fax Number:
708-877-4818

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14301 INDEPENDENCE WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOMER GLEN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60491-7210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-509-2800
Provider Business Practice Location Address Fax Number:
708-877-4818
Provider Enumeration Date:
07/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ZANDSTRA
Authorized Official First Name:
JOHANNA
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT OF OPERATIONS
Authorized Official Telephone Number:
708-342-8100

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  1010138 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 147559 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50070 . This is a "BC/BS PREFERRED PROVIDER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1010138 . This is a "IL DEPT. OF PUBLIC HEALT" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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