Provider Demographics
NPI:1760488779
Name:TABOR HILLS HEALTHCARE FACILITY, INC
Entity Type:Organization
Organization Name:TABOR HILLS HEALTHCARE FACILITY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:
Authorized Official - Last Name:SALINAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-778-6677
Mailing Address - Street 1:1347 CRYSTAL AVE
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-0149
Mailing Address - Country:US
Mailing Address - Phone:630-778-6677
Mailing Address - Fax:630-548-9540
Practice Address - Street 1:1347 CRYSTAL AVE
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-0149
Practice Address - Country:US
Practice Address - Phone:630-778-6677
Practice Address - Fax:630-548-9540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0040543314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL5619540001Medicare NSC
IL=========001Medicaid