Provider Demographics
NPI:1164450532
Name:B&D HOTEL CORPORATION
Entity Type:Organization
Organization Name:B&D HOTEL CORPORATION
Other - Org Name:CENTRAL PLAZA RESIDENTIAL HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:ELISA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:SHLOFROCK-ZUSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-441-8200
Mailing Address - Street 1:465 CENTRAL AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-3045
Mailing Address - Country:US
Mailing Address - Phone:847-441-8200
Mailing Address - Fax:847-441-0800
Practice Address - Street 1:321 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60644-2227
Practice Address - Country:US
Practice Address - Phone:773-626-2300
Practice Address - Fax:773-626-7647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1715281310500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid