Organization
MARIANJOY AT PROVIDENCE VICTORIAN VILLAGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LAURA J. BOOKER (PFS CONTRACTED LEAD)
(630) 909-7374
Entity
Organization
Contact information
Practice address
12525 RENAISSANCE CIR, HOMER GLEN, IL 60491-5896
(708) 590-5050
Mailing address
12525 RENAISSANCE CIR, HOMER GLEN, IL 60491-5896
(708) 590-5050
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
01/22/2015
Last updated
01/22/2015
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