Provider Demographics
NPI:1801166962
Name:TN CARE, LLC
Entity type:Organization
Organization Name:TN CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NICKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-501-0996
Mailing Address - Street 1:1S443 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-3989
Mailing Address - Country:US
Mailing Address - Phone:847-767-5763
Mailing Address - Fax:
Practice Address - Street 1:1615 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60087-3810
Practice Address - Country:US
Practice Address - Phone:847-244-6700
Practice Address - Fax:847-244-7925
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JLM FINANCIAL HEALTHCARE, LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-06
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0051664Medicaid