Provider Demographics
NPI:1750351425
Name:WESTMINSTER PLACE
Entity type:Organization
Organization Name:WESTMINSTER PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:HAVRILKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-979-3904
Mailing Address - Street 1:8707 SKOKIE BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-2283
Mailing Address - Country:US
Mailing Address - Phone:847-979-3955
Mailing Address - Fax:847-979-3969
Practice Address - Street 1:3200 GRANT ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1903
Practice Address - Country:US
Practice Address - Phone:847-492-4871
Practice Address - Fax:847-570-3426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM2500X
IL0012930310400000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2100 1633224OtherBCBS
IL2100 1633224OtherBCBS