Provider Demographics
NPI:1659790889
Name:EVANGELICAL RETIREMENT HOMES OF GREATER CHICAGO, INC.
Entity Type:Organization
Organization Name:EVANGELICAL RETIREMENT HOMES OF GREATER CHICAGO, INC.
Other - Org Name:FRIENDSHIP VILLAGE OF SCHAUMBURG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:NYBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-843-4259
Mailing Address - Street 1:350 W SCHAUMBURG RD
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60194-3464
Mailing Address - Country:US
Mailing Address - Phone:847-884-5530
Mailing Address - Fax:847-884-5053
Practice Address - Street 1:350 W SCHAUMBURG RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60194-3464
Practice Address - Country:US
Practice Address - Phone:847-884-5530
Practice Address - Fax:847-884-5053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherEIN