Provider Demographics
NPI:1205951514
Name:SNOW VALLEY NURSING AND REHABILITATION CENTER, LLC
Entity type:Organization
Organization Name:SNOW VALLEY NURSING AND REHABILITATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:STEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-905-3000
Mailing Address - Street 1:5000 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-2117
Mailing Address - Country:US
Mailing Address - Phone:630-852-5100
Mailing Address - Fax:630-852-5148
Practice Address - Street 1:5000 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-2117
Practice Address - Country:US
Practice Address - Phone:630-852-5100
Practice Address - Fax:630-852-5148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0046185314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL50248OtherBLUE CROSS BLUE SHIELD
IL=========001Medicaid
IL50248OtherBLUE CROSS BLUE SHIELD