Provider Demographics
NPI:1609320761
Name:MARKLUND CHILDREN'S HOME
Entity Type:Organization
Organization Name:MARKLUND CHILDREN'S HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDNET
Authorized Official - Prefix:MR
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:FONGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-593-5476
Mailing Address - Street 1:1S450 WYATT DR
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-4921
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1S450 WYATT DR
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4921
Practice Address - Country:US
Practice Address - Phone:630-593-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-06
Last Update Date:2016-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities