NPIMap

Organization Active NPI

Rest Haven Illiana Christian Convalescent Home

  • Skilled Nursing Facility
  • South Holland, IL
National Provider Identifier
1124020474
Registry record updated Apr 14, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
0023242 Issued in IL
Legal business name
REST HAVEN ILLIANA CHRISTIAN CONVALESCENT HOME
Practice address
16300 Wausau Ave
South Holland, IL 60473-2158
Phone
(708) 596-5500
Fax
(708) 596-5527
NPI assigned
Jun 1, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2009

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

Authorized official

Name
Ms. Joan C McCarthy
Title
VP Operational Systems
Phone
(708) 342-8179

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 0023242 IL Primary

Addresses

Primary practice location

16300 Wausau Ave
South Holland, IL 60473-2158

Mailing address

16300 Wausau Ave
South Holland, IL 60473-2158
Phone (708) 596-5500

Other names 1

  • Providence Healthcare and Rehabilitation Center South Holland Doing business as

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1117584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1239667200000",
    "number": "1124020474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16300 WAUSAU AVE",
            "city": "SOUTH HOLLAND",
            "state": "IL",
            "postal_code": "604732158",
            "telephone_number": "708-596-5500",
            "fax_number": "708-596-5527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16300 WAUSAU AVE",
            "city": "SOUTH HOLLAND",
            "state": "IL",
            "postal_code": "604732158",
            "telephone_number": "708-596-5500",
            "fax_number": "708-596-5527"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REST HAVEN ILLIANA CHRISTIAN CONVALESCENT HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-01",
        "last_updated": "2009-04-14",
        "status": "A",
        "authorized_official_last_name": "MCCARTHY",
        "authorized_official_first_name": "JOAN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "VP OPERATIONAL SYSTEMS",
        "authorized_official_telephone_number": "708-342-8179",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "0023242",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Healthcare and Rehabilitation Center South Holland",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in South Holland, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2009; 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.