Provider Demographics
NPI:1083819726
Name:BOHEMIAN HOME FOR THE AGED
Entity Type:Organization
Organization Name:BOHEMIAN HOME FOR THE AGED
Other - Org Name:TABOR HILLS SUPPORTIVE COMMUNITY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:
Authorized Official - Last Name:SALINAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-778-6677
Mailing Address - Street 1:1439 MCDOWELL ROAD
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563
Mailing Address - Country:US
Mailing Address - Phone:630-778-6677
Mailing Address - Fax:630-778-6680
Practice Address - Street 1:1347 CRYSTAL AVE
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-0149
Practice Address - Country:US
Practice Address - Phone:630-778-6677
Practice Address - Fax:630-778-6680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========002Medicaid