Provider Demographics
NPI:1750526232
Name:TRILOGY HEALTHCARE OF WILL, LLC
Entity type:Organization
Organization Name:TRILOGY HEALTHCARE OF WILL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SVP - FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:P
Authorized Official - Last Name:PLEVYAK
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:502-213-1710
Mailing Address - Street 1:1251 E RICHTON RD
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:IL
Mailing Address - Zip Code:60417-1623
Mailing Address - Country:US
Mailing Address - Phone:708-672-6700
Mailing Address - Fax:708-367-4405
Practice Address - Street 1:1251 E RICHTON RD
Practice Address - Street 2:
Practice Address - City:CRETE
Practice Address - State:IL
Practice Address - Zip Code:60417-1623
Practice Address - Country:US
Practice Address - Phone:708-672-6700
Practice Address - Fax:708-367-4405
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRILOGY FSC INVESTORS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-11
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1870437314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0045435Medicaid
IL0045435Medicaid