Provider Demographics
NPI:1023002326
Name:RESURRECTION SENIOR SERVICES
Entity Type:Organization
Organization Name:RESURRECTION SENIOR SERVICES
Other - Org Name:HOLY FAMILY NURSING & REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPOBIANCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-813-3707
Mailing Address - Street 1:100 N RIVER RD
Mailing Address - Street 2:FINANCE DIVISION, 2ND FLOOR
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-1209
Mailing Address - Country:US
Mailing Address - Phone:847-813-3722
Mailing Address - Fax:847-813-3785
Practice Address - Street 1:2380 E DEMPSTER ST
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-4839
Practice Address - Country:US
Practice Address - Phone:847-296-3335
Practice Address - Fax:847-296-2659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-01
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0026286314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
789OtherBLUE CROSS
789OtherBLUE CROSS
789OtherBLUE CROSS