Provider Demographics
NPI:1154325892
Name:HILLCREST RETIREMENT VILLAGE LTD
Entity Type:Organization
Organization Name:HILLCREST RETIREMENT VILLAGE LTD
Other - Org Name:HILLCREST NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-546-5300
Mailing Address - Street 1:1740 NORTH CIRCUIT DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE BEACH
Mailing Address - State:IL
Mailing Address - Zip Code:60073
Mailing Address - Country:US
Mailing Address - Phone:847-546-5300
Mailing Address - Fax:847-546-7563
Practice Address - Street 1:1740 CIRCUIT DR
Practice Address - Street 2:
Practice Address - City:ROUND LAKE BEACH
Practice Address - State:IL
Practice Address - Zip Code:60073-3803
Practice Address - Country:US
Practice Address - Phone:847-546-5300
Practice Address - Fax:847-546-7563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL146130Medicare Oscar/Certification