Provider Demographics
NPI:1538342456
Name:WEST SUBURBAN NURSING AND REHABILITATION CENTER, LLC
Entity type:Organization
Organization Name:WEST SUBURBAN NURSING AND REHABILITATION CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BLISKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-449-1900
Mailing Address - Street 1:311 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1979
Mailing Address - Country:US
Mailing Address - Phone:630-894-7400
Mailing Address - Fax:630-894-8528
Practice Address - Street 1:311 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1979
Practice Address - Country:US
Practice Address - Phone:630-894-7400
Practice Address - Fax:630-894-8528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0048165314000000X
IL2162045314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL145333Medicare Oscar/Certification