Provider Demographics
NPI:1548392541
Name:FOREST PARK, L.L.C.
Entity Type:Organization
Organization Name:FOREST PARK, L.L.C.
Other - Org Name:PAVILLION OF FOREST PARK, L.L.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:STEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-905-3000
Mailing Address - Street 1:8200 ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-2528
Mailing Address - Country:US
Mailing Address - Phone:708-488-9850
Mailing Address - Fax:708-488-9870
Practice Address - Street 1:8200 ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:IL
Practice Address - Zip Code:60130-2528
Practice Address - Country:US
Practice Address - Phone:708-488-9850
Practice Address - Fax:708-488-9870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0043778314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL364186094001Medicaid
IL1192OtherBLUE CROSS BLUE SHIELD
IL364186094001Medicaid