Provider Demographics
NPI:1083233076
Name:MARLEY OAKS ASSISTED LIVING RESIDENCE
Entity Type:Organization
Organization Name:MARLEY OAKS ASSISTED LIVING RESIDENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:STELLWAGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-685-5803
Mailing Address - Street 1:12631 187TH ST
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-8731
Mailing Address - Country:US
Mailing Address - Phone:815-485-5860
Mailing Address - Fax:
Practice Address - Street 1:12631 187TH ST
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8731
Practice Address - Country:US
Practice Address - Phone:815-485-5860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-10
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility