Provider Demographics
NPI:1952153777
Name:GREEN OAKS OF VALPARAISO, LLC
Entity type:Organization
Organization Name:GREEN OAKS OF VALPARAISO, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BEARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-569-0823
Mailing Address - Street 1:4882 N CONVENT ST
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-1461
Mailing Address - Country:US
Mailing Address - Phone:815-935-1992
Mailing Address - Fax:
Practice Address - Street 1:2550 MORTHLAND DR
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-6700
Practice Address - Country:US
Practice Address - Phone:219-309-2550
Practice Address - Fax:219-309-2560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-04
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility