Provider Demographics
NPI:1255306163
Name:HAMPTON PLAZA NURSING HOME
Entity Type:Organization
Organization Name:HAMPTON PLAZA NURSING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:DIATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-967-2000
Mailing Address - Street 1:9777 GREENWOOD AVENUE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714
Mailing Address - Country:US
Mailing Address - Phone:847-967-7000
Mailing Address - Fax:847-967-0886
Practice Address - Street 1:9777 GREENWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714
Practice Address - Country:US
Practice Address - Phone:847-967-7000
Practice Address - Fax:847-967-0886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid
IL145696Medicare ID - Type Unspecified