Provider Demographics
NPI:1285759795
Name:SHELTERING OAK
Entity type:Organization
Organization Name:SHELTERING OAK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:PESZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-526-8865
Mailing Address - Street 1:PO BOX 367
Mailing Address - Street 2:27888 N BEECH
Mailing Address - City:ISLAND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60042-0367
Mailing Address - Country:US
Mailing Address - Phone:847-526-3636
Mailing Address - Fax:
Practice Address - Street 1:27888 N BEECH ST
Practice Address - Street 2:
Practice Address - City:ISLAND LAKE
Practice Address - State:IL
Practice Address - Zip Code:60042-8402
Practice Address - Country:US
Practice Address - Phone:847-526-3636
Practice Address - Fax:847-526-9702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL001310500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL6008585OtherMDS FACILITY ID KEY
IL14E242OtherFEDERAL NUMBER
IL=========001OtherFACILITY PROVIDER NUMBER