Provider Demographics
NPI:1700867033
Name:SENECA NURSING HOME, INC.
Entity Type:Organization
Organization Name:SENECA NURSING HOME, INC.
Other - Org Name:LEE MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHESTER
Authorized Official - Middle Name:
Authorized Official - Last Name:PLODZIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-635-4000
Mailing Address - Street 1:1301 LEE ST
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-1514
Mailing Address - Country:US
Mailing Address - Phone:847-635-4000
Mailing Address - Fax:847-635-5016
Practice Address - Street 1:1301 LEE ST
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60018-1514
Practice Address - Country:US
Practice Address - Phone:847-635-4000
Practice Address - Fax:847-635-5016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0024356314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
50395OtherBLUECROSS BLUESHIELD - IL
IL=========001Medicaid
IL1190540001Medicare NSC
50395OtherBLUECROSS BLUESHIELD - IL
IL=========001Medicaid