Provider Demographics
NPI:1295858363
Name:MATHER HEALTH CARE INC
Entity Type:Organization
Organization Name:MATHER HEALTH CARE INC
Other - Org Name:MATHER PAVILION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:SUSSENBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-492-6760
Mailing Address - Street 1:1603 ORRINGTON AVE
Mailing Address - Street 2:STE 1800
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3841
Mailing Address - Country:US
Mailing Address - Phone:847-492-6760
Mailing Address - Fax:
Practice Address - Street 1:820 FOSTER ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3212
Practice Address - Country:US
Practice Address - Phone:847-492-7211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0044156314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL145803Medicare ID - Type UnspecifiedPROVIDER NUMBER