Provider Demographics
NPI:1033476510
Name:VICTORY CENTRE OF VERNON HILLS LLC
Entity Type:Organization
Organization Name:VICTORY CENTRE OF VERNON HILLS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RISK MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BECHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-837-0710
Mailing Address - Street 1:30 S WACKER DR STE 1010
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-7413
Mailing Address - Country:US
Mailing Address - Phone:312-837-0701
Mailing Address - Fax:312-837-0728
Practice Address - Street 1:97 W PHILLIP RD
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1723
Practice Address - Country:US
Practice Address - Phone:847-549-6070
Practice Address - Fax:847-367-5530
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PSL HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-20
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL364363583001Medicaid