NPIMap

Organization Active NPI

Crestwood Care Centre LP

  • Skilled Nursing Facility
  • Crestwood, IL
National Provider Identifier
1013993237
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
44164 Issued in IL
Legal business name
CRESTWOOD CARE CENTRE LP
Practice address
14255 Cicero Ave
Crestwood, IL 60445-2154
Phone
(708) 371-0400
Fax
(708) 371-5871
NPI assigned
Dec 20, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Michael Charles Braun
Title
Controller
Phone
(847) 583-0100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 44164 IL Primary

Addresses

Primary practice location

14255 Cicero Ave
Crestwood, IL 60445-2154

Mailing address

14255 Cicero Ave
Crestwood, IL 60445-2154
Phone (708) 371-0400

Other identifiers 2

IdentifierTypeStateIssuer
6002265OtherILIDPH FACILITY NUMBER
44164OtherILIDPH LICENSE NUMBER

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1135036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1013993237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14255 CICERO AVE",
            "city": "CRESTWOOD",
            "state": "IL",
            "postal_code": "604452154",
            "telephone_number": "708-371-0400",
            "fax_number": "708-371-5871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14255 CICERO AVE",
            "city": "CRESTWOOD",
            "state": "IL",
            "postal_code": "604452154",
            "telephone_number": "708-371-0400",
            "fax_number": "708-371-5871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESTWOOD CARE CENTRE LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BRAUN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "847-583-0100",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "44164",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IDPH FACILITY NUMBER",
            "identifier": "6002265",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IDPH LICENSE NUMBER",
            "identifier": "44164",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Crestwood, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.