Provider Demographics
NPI:1003897893
Name:WARREN BARR NURSING PAVILION, LLC
Entity Type:Organization
Organization Name:WARREN BARR NURSING PAVILION, LLC
Other - Org Name:WARREN BARR PAVILION
Other - Org Type:Other Name
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:NEELE
Authorized Official - Middle Name:E
Authorized Official - Last Name:STEARNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-720-8720
Mailing Address - Street 1:6400 SHAFER CT
Mailing Address - Street 2:SUITE 600
Mailing Address - City:ROSEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60018-4914
Mailing Address - Country:US
Mailing Address - Phone:847-720-8722
Mailing Address - Fax:847-720-8701
Practice Address - Street 1:66 W OAK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-7325
Practice Address - Country:US
Practice Address - Phone:312-705-5100
Practice Address - Fax:312-337-5041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-08
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid