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Organization

PH PROVIDENCE, LLC

Active
Other names
Providence Pavilion
Organization subpart
No

Provider details

NPI number
Authorized official
BENJAMIN KLEIN (MANAGER)
(847) 329-4100
Entity
Organization

Contact information

Practice address
401 E 20TH ST, COVINGTON, KY 41014-1583
(845) 732-9410
Mailing address
7444 LONG AVE, SKOKIE, IL 60077-3214
(847) 329-4100

Taxonomy

Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary

Other

Enumeration date
10/22/2014
Last updated
10/22/2014
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