Provider Demographics
NPI:1033179411
Name:WESTMINSTER PLACE
Entity Type:Organization
Organization Name:WESTMINSTER PLACE
Other - Org Name:PRESBYTERIAN HOMES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HAVRILKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-979-3904
Mailing Address - Street 1:8707 SKOKIE BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-2283
Mailing Address - Country:US
Mailing Address - Phone:847-979-3955
Mailing Address - Fax:847-979-3969
Practice Address - Street 1:3200 GRANT STREET
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201
Practice Address - Country:US
Practice Address - Phone:847-492-4828
Practice Address - Fax:847-492-4810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1633224OtherBLUE CROSS BLUE SHIELD OF ILLINOIS
IL1633224OtherBLUE CROSS BLUE SHIELD OF ILLINOIS