Provider Demographics
NPI:1376537670
Name:RESURRECTION SENIOR SERVICES
Entity Type:Organization
Organization Name:RESURRECTION SENIOR SERVICES
Other - Org Name:ST FRANCIS NURSING & REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPOBIANCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-792-7925
Mailing Address - Street 1:7435 W TALCOTT AVE
Mailing Address - Street 2:PROFESSIONAL BULIDING STE 340
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3707
Mailing Address - Country:US
Mailing Address - Phone:773-594-7837
Mailing Address - Fax:773-594-8567
Practice Address - Street 1:500 ASBURY AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-2724
Practice Address - Country:US
Practice Address - Phone:847-316-3322
Practice Address - Fax:847-316-3337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0044370314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
5410OtherBLUE CROSS
5410OtherBLUE CROSS
IL=========006Medicaid