Provider Demographics
NPI:1609056001
Name:FAIRVIEW CARE CENTER OF JOLIET, LLC
Entity Type:Organization
Organization Name:FAIRVIEW CARE CENTER OF JOLIET, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:YOSEF
Authorized Official - Middle Name:
Authorized Official - Last Name:MEYSTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-673-6767
Mailing Address - Street 1:8131 MONTICELLO AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-3325
Mailing Address - Country:US
Mailing Address - Phone:847-673-6767
Mailing Address - Fax:847-673-6768
Practice Address - Street 1:222 N HAMMES AVE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-8121
Practice Address - Country:US
Practice Address - Phone:815-725-0443
Practice Address - Fax:815-725-1079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0048983314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
145221Medicare PIN