Provider Demographics
NPI:1669816633
Name:THE VILLA AT SOUTH HOLLAND
Entity Type:Organization
Organization Name:THE VILLA AT SOUTH HOLLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ISRAEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-692-1152
Mailing Address - Street 1:16300 WAUSAU AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-2158
Mailing Address - Country:US
Mailing Address - Phone:708-596-5500
Mailing Address - Fax:
Practice Address - Street 1:6400 SHAFER CT
Practice Address - Street 2:SUITE 700
Practice Address - City:ROSEMONT
Practice Address - State:IL
Practice Address - Zip Code:60018-4914
Practice Address - Country:US
Practice Address - Phone:847-825-5386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility