Provider Demographics
NPI:1487855581
Name:PARK HAVEN NURSING & REHABILITATION CENTER LLC
Entity Type:Organization
Organization Name:PARK HAVEN NURSING & REHABILITATION CENTER LLC
Other - Org Name:INTEGRITY HEALTHCARE OF SMITHTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLISKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-426-2315
Mailing Address - Street 1:4213 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-2046
Mailing Address - Country:US
Mailing Address - Phone:708-236-0000
Mailing Address - Fax:708-236-0001
Practice Address - Street 1:107 SOUTH LINCOLN
Practice Address - Street 2:
Practice Address - City:SMITHTON
Practice Address - State:IL
Practice Address - Zip Code:62285-1617
Practice Address - Country:US
Practice Address - Phone:618-235-4600
Practice Address - Fax:618-235-5829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility