Provider Demographics
NPI:1669638789
Name:GILMAN HEALTHCARE CENTER, LLC
Entity Type:Organization
Organization Name:GILMAN HEALTHCARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BARAK
Authorized Official - Middle Name:
Authorized Official - Last Name:BAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-206-9079
Mailing Address - Street 1:2824 W COYLE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-2922
Mailing Address - Country:US
Mailing Address - Phone:312-206-9079
Mailing Address - Fax:
Practice Address - Street 1:1390 S CRESCENT ST
Practice Address - Street 2:
Practice Address - City:GILMAN
Practice Address - State:IL
Practice Address - Zip Code:60938-6129
Practice Address - Country:US
Practice Address - Phone:815-265-7208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
14-5347OtherMEDICARE