Provider Demographics
NPI:1689671349
Name:GLENSHIRE NURSING REHABILITATION CENTER LTD
Entity Type:Organization
Organization Name:GLENSHIRE NURSING REHABILITATION CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GLENNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-674-5454
Mailing Address - Street 1:5454 FARGO AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-3210
Mailing Address - Country:US
Mailing Address - Phone:847-674-5454
Mailing Address - Fax:847-674-8311
Practice Address - Street 1:22660 CICERO AVE
Practice Address - Street 2:
Practice Address - City:RICHTON PARK
Practice Address - State:IL
Practice Address - Zip Code:60471-1700
Practice Address - Country:US
Practice Address - Phone:708-747-6120
Practice Address - Fax:707-747-6491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL39321314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL145424Medicare Oscar/Certification