Provider Demographics
NPI:1083710883
Name:ELMWOOD TERRACE HEALTHCARE INC
Entity Type:Organization
Organization Name:ELMWOOD TERRACE HEALTHCARE INC
Other - Org Name:ELMWOOD CENTER NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.F.O
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ABELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-338-4400
Mailing Address - Street 1:1017 W GALENA BLVD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-3753
Mailing Address - Country:US
Mailing Address - Phone:630-897-3100
Mailing Address - Fax:630-897-3102
Practice Address - Street 1:1017 W GALENA BLVD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-3753
Practice Address - Country:US
Practice Address - Phone:630-897-3100
Practice Address - Fax:630-897-3102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0046128314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6002844OtherFACILITY ID
IL6002844OtherFACILITY ID