Provider Demographics
NPI:1043385966
Name:HALSTED TERRACE NURSING CENTER INC
Entity Type:Organization
Organization Name:HALSTED TERRACE NURSING CENTER INC
Other - Org Name:HALSTED TERRACE NURSING
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:T
Authorized Official - Last Name:SLESUR
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:847-763-2550
Mailing Address - Street 1:10935 S HALSTED ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628
Mailing Address - Country:US
Mailing Address - Phone:773-928-2000
Mailing Address - Fax:773-928-9154
Practice Address - Street 1:10935 S HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628
Practice Address - Country:US
Practice Address - Phone:773-928-2000
Practice Address - Fax:773-928-9154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL000020842314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
10PHLIC000020842Medicare ID - Type Unspecified
145764Medicare Oscar/Certification