Provider Demographics
NPI:1376539767
Name:OAK BROOK HEALTHCARE CENTRE, LTD.
Entity Type:Organization
Organization Name:OAK BROOK HEALTHCARE CENTRE, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P. FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:VICERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-604-4416
Mailing Address - Street 1:2013 MIDWEST RD
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1312
Mailing Address - Country:US
Mailing Address - Phone:630-495-0220
Mailing Address - Fax:630-629-5760
Practice Address - Street 1:2013 MIDWEST RD
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1312
Practice Address - Country:US
Practice Address - Phone:630-495-0220
Practice Address - Fax:630-629-5760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid