Provider Demographics
NPI:1679578041
Name:GENERATIONS AT COLUMBUS PARK,INC
Entity type:Organization
Organization Name:GENERATIONS AT COLUMBUS PARK,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WINTER
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:847-675-7979
Mailing Address - Street 1:6840 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-2628
Mailing Address - Country:US
Mailing Address - Phone:847-675-7979
Mailing Address - Fax:847-674-5267
Practice Address - Street 1:901 S AUSTIN BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60644-5304
Practice Address - Country:US
Practice Address - Phone:773-287-5959
Practice Address - Fax:773-287-7909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-14
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0037960314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL145834Medicare Oscar/Certification
IL6049320001Medicare NSC