Provider Demographics
NPI:1629298195
Name:DEKALB AREA RETIREMENT CENTER
Entity Type:Organization
Organization Name:DEKALB AREA RETIREMENT CENTER
Other - Org Name:OAK CREST
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:CICHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-756-8461
Mailing Address - Street 1:2944 GREENWOOD ACRES DRIVE
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-4949
Mailing Address - Country:US
Mailing Address - Phone:815-756-8461
Mailing Address - Fax:815-756-6515
Practice Address - Street 1:2944 GREENWOOD ACRES DRIVE
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-4949
Practice Address - Country:US
Practice Address - Phone:815-756-8461
Practice Address - Fax:815-756-6515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0025163314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL146105Medicare ID - Type UnspecifiedPROVIDER NUMBER