Provider Demographics
NPI:1245383702
Name:WASHINGTON & JANE SMITH COMMUNITY - ORLAND PARK
Entity Type:Organization
Organization Name:WASHINGTON & JANE SMITH COMMUNITY - ORLAND PARK
Other - Org Name:SMITH CROSSING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARNERIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-474-7350
Mailing Address - Street 1:10501 EMILIE LN
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-8805
Mailing Address - Country:US
Mailing Address - Phone:708-226-1800
Mailing Address - Fax:708-326-2770
Practice Address - Street 1:10501 EMILIE LN
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-8805
Practice Address - Country:US
Practice Address - Phone:708-226-1800
Practice Address - Fax:708-326-2770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0046698314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0046698OtherSTATE LIC. NUMBER
IL0046698OtherSTATE LIC. NUMBER