Provider Demographics
NPI:1922347293
Name:FRIENDSHIP VILLAGE OF MILL CREEK
Entity Type:Organization
Organization Name:FRIENDSHIP VILLAGE OF MILL CREEK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRES & CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:FLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-884-5371
Mailing Address - Street 1:0N801 FRIENDSHIP WAY
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-6206
Mailing Address - Country:US
Mailing Address - Phone:630-578-6500
Mailing Address - Fax:630-938-7800
Practice Address - Street 1:0N801 FRIENDSHIP WAY
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-6206
Practice Address - Country:US
Practice Address - Phone:630-578-6500
Practice Address - Fax:630-938-7800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-06
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL5103954310400000X
IL0050286314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility