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Organization
PRESBYTERIAN HOMES
Active
Organization
PRESBYTERIAN HOMES
Active
Other names
Lake Forest Place
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT E LANDSMAN (VICE PRESIDENT OF FINANCE)
(847) 492-4859
Entity
Organization
Contact information
Practice address
1100 PEMBRIDGE DR, LAKE FOREST, IL 60045
(847) 604-6700
(847) 604-6604
Mailing address
3200 GRANT ST, ATTN ACCOUNTING DEPARTMENT, EVANSTON, IL 60201
(847) 492-4871
(847) 570-3426
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
0044065
IL
310400000X
Assisted Living Facility
0044065
IL
314000000X
Skilled Nursing Facility
0044065
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2100
BCBS
—
01
—
4932281
BCBS
—
Enumeration date
01/23/2006
Last updated
08/12/2008
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