Provider Demographics
NPI:1982835229
Name:HERITAGE WOODS OF SOUTH ELGIN
Entity Type:Organization
Organization Name:HERITAGE WOODS OF SOUTH ELGIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GRACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAUSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-531-8360
Mailing Address - Street 1:700 N MCLEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60177-1429
Mailing Address - Country:US
Mailing Address - Phone:847-531-8360
Mailing Address - Fax:847-531-8362
Practice Address - Street 1:700 N MCLEAN BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60177-1429
Practice Address - Country:US
Practice Address - Phone:847-531-8360
Practice Address - Fax:847-531-8362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility