Provider Demographics
NPI:1457746083
Name:PAXTON HEALTHCARE AND REHAB LLC
Entity Type:Organization
Organization Name:PAXTON HEALTHCARE AND REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:STANLEY
Authorized Official - Last Name:JANUSZEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-674-4700
Mailing Address - Street 1:1240 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:PAXTON
Mailing Address - State:IL
Mailing Address - Zip Code:60957-4158
Mailing Address - Country:US
Mailing Address - Phone:217-379-4896
Mailing Address - Fax:217-379-2561
Practice Address - Street 1:3856 OAKTON ST STE 200
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-3455
Practice Address - Country:US
Practice Address - Phone:847-674-4700
Practice Address - Fax:847-674-4733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-31
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2192487314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
146005Medicare PIN