Provider Demographics
NPI:1053316430
Name:GENERATIONS AT ELMWOOD PARK, INC.
Entity Type:Organization
Organization Name:GENERATIONS AT ELMWOOD PARK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WINTER
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:847-674-5200
Mailing Address - Street 1:6840 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-2628
Mailing Address - Country:US
Mailing Address - Phone:847-674-5200
Mailing Address - Fax:847-674-5267
Practice Address - Street 1:7733 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:ELMWOOD PARK
Practice Address - State:IL
Practice Address - Zip Code:60707-1820
Practice Address - Country:US
Practice Address - Phone:708-452-9200
Practice Address - Fax:708-452-9294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0040410314000000X
IL801332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6036630001Medicare NSC
IL145419Medicare Oscar/Certification