Organization
REST HAVEN ILLIANA CHRISTIAN CONVALESCENT HOME
Active
Other names
Providence at Home
Organization subpart
No
Provider details
NPI number
Authorized official
JOHANNA ZANDSTRA (VICE PRESIDENT OF OPERATIONS)
(708) 342-8100
Entity
Organization
Contact information
Practice address
14301 INDEPENDENCE WAY, HOMER GLEN, IL 60491-7210
(800) 509-2800
(708) 877-4818
Mailing address
14301 INDEPENDENCE WAY, HOMER GLEN, IL 60491-7210
(800) 509-2800
(708) 877-4818
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
1010138
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1010138
IL DEPT. OF PUBLIC HEALT
IL
01
—
147559
MEDICARE
—
01
—
50070
BC/BS PREFERRED PROVIDER
IL
Enumeration date
07/19/2005
Last updated
10/01/2025
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