Provider Demographics
NPI:1649588260
Name:CHURCH STREET STATION SKILLED NURSING AND LIVING CENTER, LLC
Entity Type:Organization
Organization Name:CHURCH STREET STATION SKILLED NURSING AND LIVING CENTER, LLC
Other - Org Name:CLAREMONT HANOVER PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:FLATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-745-6224
Mailing Address - Street 1:7257 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-1810
Mailing Address - Country:US
Mailing Address - Phone:847-745-6226
Mailing Address - Fax:847-556-0446
Practice Address - Street 1:2000 W. LAKE ST.
Practice Address - Street 2:
Practice Address - City:HANOVER PARK
Practice Address - State:IL
Practice Address - Zip Code:60133
Practice Address - Country:US
Practice Address - Phone:630-556-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility