Provider Demographics
NPI:1548257454
Name:ARBOUR HEALTH CARE CENTER LTD
Entity type:Organization
Organization Name:ARBOUR HEALTH CARE CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:LYDIA
Authorized Official - Last Name:PATTY
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:773-465-7751
Mailing Address - Street 1:3737 W ARTHUR AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-4029
Mailing Address - Country:US
Mailing Address - Phone:847-679-2121
Mailing Address - Fax:773-465-2104
Practice Address - Street 1:1512 W FARGO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-1805
Practice Address - Country:US
Practice Address - Phone:773-465-7751
Practice Address - Fax:773-465-2104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0034736314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
213112Medicare PIN