Provider Demographics
NPI:1891765996
Name:PRESBYTERIAN HOMES
Entity type:Organization
Organization Name:PRESBYTERIAN HOMES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:LANDSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-492-4859
Mailing Address - Street 1:811 E CENTRAL RD
Mailing Address - Street 2:ATTN ACCOUNTING DEPARTMENT
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-3244
Mailing Address - Country:US
Mailing Address - Phone:847-437-6700
Mailing Address - Fax:847-956-4451
Practice Address - Street 1:811 E CENTRAL RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-3244
Practice Address - Country:US
Practice Address - Phone:847-437-6700
Practice Address - Fax:847-956-4451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-23
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0045047314000000X, 310400000X
261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
2100 1634133OtherBCBS
IL146007Medicare Oscar/Certification