Provider Demographics
NPI:1114903754
Name:SLOVAK AMERICAN CHARITABLE ASSOCIATION
Entity Type:Organization
Organization Name:SLOVAK AMERICAN CHARITABLE ASSOCIATION
Other - Org Name:ROLLING HILLS MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:STEFO
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:847-746-2147
Mailing Address - Street 1:3615 16TH ST
Mailing Address - Street 2:
Mailing Address - City:ZION
Mailing Address - State:IL
Mailing Address - Zip Code:60099-1423
Mailing Address - Country:US
Mailing Address - Phone:847-746-8382
Mailing Address - Fax:847-746-3534
Practice Address - Street 1:3615 16TH ST
Practice Address - Street 2:
Practice Address - City:ZION
Practice Address - State:IL
Practice Address - Zip Code:60099-1423
Practice Address - Country:US
Practice Address - Phone:847-746-8382
Practice Address - Fax:847-746-3534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-15
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0025239314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0025239Medicaid
IL0025239Medicaid