# REST HAVEN ILLIANA CHRISTIAN CONVALESCENT HOME

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Providence at Home
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568461820
- **Authorized official:** JOHANNA ZANDSTRA (VICE PRESIDENT OF OPERATIONS)
- **Authorized official phone:** (708) 342-8100

## Contact information

- **Practice address:** 14301 INDEPENDENCE WAY, HOMER GLEN, IL 60491-7210
- **Practice address phone:** (800) 509-2800
- **Practice address fax:** (708) 877-4818
- **Mailing address:** 14301 INDEPENDENCE WAY, HOMER GLEN, IL 60491-7210
- **Mailing address phone:** (800) 509-2800
- **Mailing address fax:** (708) 877-4818

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | 1010138 | IL | Yes |

## Other

- **Enumeration date:** 07/19/2005
- **Last updated:** 10/01/2025