Organization
WESTMINSTER PLACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK E. HAVRILKA (CHIEF FINANCIAL OFFICER)
(847) 979-3904
Entity
Organization
Contact information
Practice address
3200 GRANT ST, EVANSTON, IL 60201-1903
(847) 492-4871
(847) 570-3426
Mailing address
8707 SKOKIE BLVD STE 400, SKOKIE, IL 60077-2283
(847) 979-3955
(847) 979-3969
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
—
—
310400000X
Assisted Living Facility
0012930
IL
314000000X
Skilled Nursing Facility
Primary
0012930
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2100 1633224
BCBS
IL
Enumeration date
01/25/2006
Last updated
10/08/2021
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