Provider Demographics
NPI:1003924721
Name:EVANGELICAL RETIREMENT HOMES OF GREATER CHICAGO, INC.
Entity Type:Organization
Organization Name:EVANGELICAL RETIREMENT HOMES OF GREATER CHICAGO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P./ CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:FLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-884-5371
Mailing Address - Street 1:350 W SCHAUMBURG RD
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60194-3464
Mailing Address - Country:US
Mailing Address - Phone:847-884-5000
Mailing Address - Fax:847-884-5718
Practice Address - Street 1:350 W SCHAUMBURG RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60194-3464
Practice Address - Country:US
Practice Address - Phone:847-884-5000
Practice Address - Fax:847-884-5718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL000023218310400000X
IL0023218314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL000023218Medicaid
IL145341Medicare Oscar/Certification