Provider Demographics
NPI:1336347129
Name:FOREST VILLA REHABILITATION AND NURSING CENTER
Entity Type:Organization
Organization Name:FOREST VILLA REHABILITATION AND NURSING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPY ASST.
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:847-647-6400
Mailing Address - Street 1:7043 W SUMMERDALE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60656-1942
Mailing Address - Country:US
Mailing Address - Phone:777-837-6009
Mailing Address - Fax:
Practice Address - Street 1:6840 W TOUHY AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-4520
Practice Address - Country:US
Practice Address - Phone:847-647-6400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility