Provider Demographics
NPI:1730183203
Name:BALMORAL HOME INC
Entity type:Organization
Organization Name:BALMORAL HOME INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:YONATHAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:STERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-561-8661
Mailing Address - Street 1:6500 N HAMLIN AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-3904
Mailing Address - Country:US
Mailing Address - Phone:847-679-7484
Mailing Address - Fax:847-679-7484
Practice Address - Street 1:2055 W BALMORAL AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-1001
Practice Address - Country:US
Practice Address - Phone:773-561-8661
Practice Address - Fax:773-561-9376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-12
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL000039966314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1012OtherBLUECROSS BLUESHIELD
IL=========801Medicaid
IL=========001Medicaid
IL=========001Medicaid
IL145796Medicare PIN