Organization
PAVILION OF WAUKEGAN, II, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. NANCY C MASONI (DIRECTOR OF FINANCE)
(847) 997-1750
Entity
Organization
Contact information
Practice address
2217 WASHINGTON ST, WAUKEGAN, IL 60085-5060
(847) 997-1750
(773) 478-0320
Mailing address
6350 N AVERS AVE, CHICAGO, IL 60659-1029
(847) 997-1750
(773) 478-0320
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
0036467
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1167
BCBS OF IL INSURANCE
IL
Enumeration date
02/27/2007
Last updated
02/04/2009
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