Provider Demographics
NPI:1063472520
Name:PRESBYTERIAN HOMES
Entity Type:Organization
Organization Name:PRESBYTERIAN HOMES
Other - Org Name:LAKE FOREST PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:LANDSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-492-4859
Mailing Address - Street 1:3200 GRANT STREET
Mailing Address - Street 2:ATTN ACCOUNTING DEPARTMENT
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201
Mailing Address - Country:US
Mailing Address - Phone:847-492-4871
Mailing Address - Fax:847-570-3426
Practice Address - Street 1:1100 PEMBRIDGE DRIVE
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045
Practice Address - Country:US
Practice Address - Phone:847-604-6700
Practice Address - Fax:847-570-3426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04932281OtherBLUE CROSS BLUE SHIELD ILLINOIS
IL04932281OtherBLUE CROSS BLUE SHIELD ILLINOIS