Provider Demographics
NPI:1245420173
Name:PLUM CREEK SUPPORTIVE LIVING
Entity Type:Organization
Organization Name:PLUM CREEK SUPPORTIVE LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-670-8080
Mailing Address - Street 1:2801 ALGONQUIN RD
Mailing Address - Street 2:
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-3823
Mailing Address - Country:US
Mailing Address - Phone:847-670-8080
Mailing Address - Fax:847-368-1330
Practice Address - Street 1:2801 ALGONQUIN RD
Practice Address - Street 2:
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-3823
Practice Address - Country:US
Practice Address - Phone:847-670-8080
Practice Address - Fax:847-368-1330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility