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Organization

CRESTWOOD CARE CENTRE LP

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. MICHAEL CHARLES BRAUN (CONTROLLER)
(847) 583-0100
Entity
Organization

Contact information

Practice address
14255 CICERO AVE, CRESTWOOD, IL 60445-2154
(708) 371-0400
(708) 371-5871
Mailing address
14255 CICERO AVE, CRESTWOOD, IL 60445-2154
(708) 371-0400
(708) 371-5871

Taxonomy

Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
44164
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
44164
IDPH LICENSE NUMBER
IL
01
6002265
IDPH FACILITY NUMBER
IL
Enumeration date
12/20/2005
Last updated
08/22/2020
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