Provider Demographics
NPI:1972951812
Name:CITADEL ESTATES-HAZEL CREST, LLC
Entity Type:Organization
Organization Name:CITADEL ESTATES-HAZEL CREST, LLC
Other - Org Name:CITADEL ESTATES-HAZEL CREST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHON
Authorized Official - Middle Name:
Authorized Official - Last Name:AARON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-470-2044
Mailing Address - Street 1:3701 W 183RD ST
Mailing Address - Street 2:
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-2512
Mailing Address - Country:US
Mailing Address - Phone:708-799-7099
Mailing Address - Fax:708-799-9267
Practice Address - Street 1:3701 W 183RD ST
Practice Address - Street 2:
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2512
Practice Address - Country:US
Practice Address - Phone:708-799-7099
Practice Address - Fax:708-799-9267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0053777310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility