Provider Demographics
NPI:1104839869
Name:PLUM GROVE NURSING & REHAB CENTER LLC
Entity type:Organization
Organization Name:PLUM GROVE NURSING & REHAB CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ATTORNEY
Authorized Official - Prefix:MS
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:
Authorized Official - Last Name:MEEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-207-6468
Mailing Address - Street 1:24 SOUTH PLUM GROVE ROAD
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067
Mailing Address - Country:US
Mailing Address - Phone:847-358-0311
Mailing Address - Fax:
Practice Address - Street 1:24 SOUTH PLUM GROVE ROAD
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067
Practice Address - Country:US
Practice Address - Phone:847-358-0311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
14-5658Medicare ID - Type Unspecified