Provider Demographics
NPI:1760649966
Name:MARKLUND MILL CREEK HOME 3
Entity Type:Organization
Organization Name:MARKLUND MILL CREEK HOME 3
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-593-5500
Mailing Address - Street 1:1S450 WYATT DR
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-4921
Mailing Address - Country:US
Mailing Address - Phone:360-593-5500
Mailing Address - Fax:
Practice Address - Street 1:1S381 WYATT DR
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4921
Practice Address - Country:US
Practice Address - Phone:630-593-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARKLUND CHILDRENS HOME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-16
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL000047258315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities