Provider Demographics
NPI:1164972667
Name:APOSTOLIC CHRISTIAN RESTHAVEN
Entity Type:Organization
Organization Name:APOSTOLIC CHRISTIAN RESTHAVEN
Other - Org Name:HIGHLAND OAKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:KINSINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-741-4543
Mailing Address - Street 1:2750 W HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60124-4202
Mailing Address - Country:US
Mailing Address - Phone:847-741-4543
Mailing Address - Fax:
Practice Address - Street 1:2750 W HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60124-4202
Practice Address - Country:US
Practice Address - Phone:847-741-4543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-07
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0029892314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14A383Medicaid