Organization
PRAIRIE GREEN AT FAY'S POINT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARMEN BALLENTINE (MEDICAID COMPLIANCE MANAGER)
(708) 754-5700
Entity
Organization
Contact information
Practice address
1546 WATER ST, BLUE ISLAND, IL 60406-2708
(708) 754-5700
Mailing address
1546 WATER ST, BLUE ISLAND, IL 60406-2708
(708) 754-5700
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
08/25/2014
Last updated
08/25/2014
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