Organization
SHELTERING OAK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LEONARD PESZ (GENERAL MANAGER)
(847) 526-8865
Entity
Organization
Contact information
Practice address
27888 N BEECH ST, ISLAND LAKE, IL 60042-8402
(847) 526-3636
(847) 526-9702
Mailing address
PO BOX 367, 27888 N BEECH, ISLAND LAKE, IL 60042-0367
(847) 526-3636
Taxonomy
Speciality
Code
Description
License number
State
310500000X
Mental Illness Intermediate Care Facility
Primary
001
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14E242
FEDERAL NUMBER
IL
01
—
IL6008585
MDS FACILITY ID KEY
IL
Enumeration date
03/21/2007
Last updated
07/21/2022
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