Organization
PAVILION ON MAIN STREET LLC
Active
Other names
Pavilion on Main Street
Organization subpart
No
Provider details
NPI number
Authorized official
MARCELLA GRAF (CFO)
(224) 470-2044
Entity
Organization
Contact information
Practice address
515 N MAIN ST, SANDWICH, IL 60548-1253
(815) 786-8426
(815) 786-6487
Mailing address
3755 CHASE AVE, SKOKIE, IL 60076-4008
(224) 470-2044
(224) 470-2952
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6008379
—
IL
Enumeration date
05/24/2022
Last updated
11/04/2025
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