Provider Demographics
NPI:1104803394
Name:GILMAN NURSING CENTER, LLC
Entity type:Organization
Organization Name:GILMAN NURSING CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER MEMBER LLC
Authorized Official - Prefix:MR
Authorized Official - First Name:MORRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:STEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-831-0201
Mailing Address - Street 1:PO BOX 597523
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-7523
Mailing Address - Country:US
Mailing Address - Phone:847-831-0201
Mailing Address - Fax:847-831-0345
Practice Address - Street 1:1390 S CRESCENT
Practice Address - Street 2:ROUTE 45 SOUTH
Practice Address - City:GILMAN
Practice Address - State:IL
Practice Address - Zip Code:60938
Practice Address - Country:US
Practice Address - Phone:815-265-7208
Practice Address - Fax:815-265-0345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0044263314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL364264598001Medicaid
IL145347Medicare Oscar/Certification
14-5347Medicare ID - Type Unspecified