Provider Demographics
NPI:1679743959
Name:VILLAGE OF DOLTON
Entity type:Organization
Organization Name:VILLAGE OF DOLTON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:PASTERNAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-201-3381
Mailing Address - Street 1:1515 E 154TH ST
Mailing Address - Street 2:
Mailing Address - City:DOLTON
Mailing Address - State:IL
Mailing Address - Zip Code:60419-3154
Mailing Address - Country:US
Mailing Address - Phone:708-201-3381
Mailing Address - Fax:708-841-1315
Practice Address - Street 1:1515 E 154TH ST
Practice Address - Street 2:
Practice Address - City:DOLTON
Practice Address - State:IL
Practice Address - Zip Code:60419-3154
Practice Address - Country:US
Practice Address - Phone:708-201-3381
Practice Address - Fax:708-841-1315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
310400000X
IL001310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility