Provider Demographics
NPI:1902413537
Name:CITADEL OF GLENVIEW LLC
Entity Type:Organization
Organization Name:CITADEL OF GLENVIEW LLC
Other - Org Name:THE CITADEL OF GLENVIEW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARCELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-470-2044
Mailing Address - Street 1:3755 CHASE AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-4008
Mailing Address - Country:US
Mailing Address - Phone:224-470-2044
Mailing Address - Fax:224-470-2952
Practice Address - Street 1:1700 E LAKE AVE
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-2003
Practice Address - Country:US
Practice Address - Phone:847-729-1300
Practice Address - Fax:847-729-9620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-28
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0044768Medicaid