Organization
MAPLE CROSSING AT AMBOY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MOSHE HERMAN (MEMBER)
(847) 982-2300
Entity
Organization
Contact information
Practice address
15 W WASSON RD, AMBOY, IL 61310-1141
(815) 857-2550
Mailing address
4950 MADISON ST STE 429, SKOKIE, IL 60077-2570
(847) 982-2300
(847) 982-2304
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
0054627
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0054627
IL DEPT OF PUBLIC HEALTH
IL
Enumeration date
07/03/2017
Last updated
07/25/2024
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