Provider Demographics
NPI:1225603673
Name:CRESCENT CARE NURSING AND REHABILITATION OF ELGIN LLC
Entity Type:Organization
Organization Name:CRESCENT CARE NURSING AND REHABILITATION OF ELGIN LLC
Other - Org Name:CRESCENT CARE OF ELGIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARCELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-470-2044
Mailing Address - Street 1:3755 CHASE AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-4008
Mailing Address - Country:US
Mailing Address - Phone:224-470-2044
Mailing Address - Fax:224-470-2952
Practice Address - Street 1:180 S STATE ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-6429
Practice Address - Country:US
Practice Address - Phone:847-742-3310
Practice Address - Fax:847-742-0924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-26
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6000277Medicaid