Provider Demographics
NPI:1376840538
Name:PINE CREST HEALTH CARE LLC
Entity Type:Organization
Organization Name:PINE CREST HEALTH CARE LLC
Other - Org Name:PINE CREST HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ATTORNEY
Authorized Official - Prefix:MS
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:
Authorized Official - Last Name:MEEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-521-2467
Mailing Address - Street 1:3300 175TH ST
Mailing Address - Street 2:
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-1604
Mailing Address - Country:US
Mailing Address - Phone:708-335-2400
Mailing Address - Fax:708-335-1825
Practice Address - Street 1:3300 175TH ST
Practice Address - Street 2:
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-1604
Practice Address - Country:US
Practice Address - Phone:708-335-2400
Practice Address - Fax:708-335-1825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-23
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL145220Medicare UPIN