Provider Demographics
NPI:1326137241
Name:EVANGELICAL RETIREMENT HOMES OF GREATER CHICAGO
Entity Type:Organization
Organization Name:EVANGELICAL RETIREMENT HOMES OF GREATER CHICAGO
Other - Org Name:FRIENDSHIP VILLAGE HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:LOOP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-755-2022
Mailing Address - Street 1:350 W SCHAUMBURG RD
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60194-3464
Mailing Address - Country:US
Mailing Address - Phone:847-884-5040
Mailing Address - Fax:847-884-5368
Practice Address - Street 1:350 W SCHAUMBURG RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60194-3464
Practice Address - Country:US
Practice Address - Phone:847-884-5040
Practice Address - Fax:847-884-5368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1003334251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health