Organization
REST HAVEN ILLIANA CHRISTIAN CONVALESCENT HOME
Active
Other names
Providence at Home, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
JOHANNA ZANDSTRA (VICE PRESIDENT OF OPERATIONS)
(708) 342-8100
Entity
Organization
Contact information
Practice address
10700 PARK PL, SAINT JOHN, IN 46373-8666
(800) 509-2800
(219) 365-3524
Mailing address
18601 N CREEK DR, TINLEY PARK, IL 60477-6397
(708) 342-8100
(708) 342-8006
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
003435
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200451170A
—
IN
01
—
50070
BC/BS PREFERRED PROVIDER
IN
Enumeration date
07/19/2005
Last updated
01/24/2024
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