Provider Demographics
NPI:1275096380
Name:PEORIA SLF, LLC
Entity Type:Organization
Organization Name:PEORIA SLF, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELCHANAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FINESTONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-674-2400
Mailing Address - Street 1:4105 OAKTON STREET
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:117 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61604-5650
Practice Address - Country:US
Practice Address - Phone:309-674-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-08
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility