Provider Demographics
NPI:1073688974
Name:GLENVIEW TERRACE NURSING CENTER
Entity Type:Organization
Organization Name:GLENVIEW TERRACE NURSING CENTER
Other - Org Name:GLENVIEW TERRACE NURSING CENTER
Other - Org Type:Doing Business As
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 1:1511 GREENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1513
Mailing Address - Country:US
Mailing Address - Phone:847-729-9090
Mailing Address - Fax:847-729-9135
Practice Address - Street 1:1511 GREENWOOD RD
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-1513
Practice Address - Country:US
Practice Address - Phone:847-729-9090
Practice Address - Fax:847-729-9135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL000026237314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
000026237OtherIDPH LIC
000026237OtherIDPH LIC
IL145268Medicare Oscar/Certification