Providence Operations, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0028605 Issued in IL

Legal business name

PROVIDENCE OPERATIONS, LLC

Doing business as

Providence Palos Heights

Practice address

13259 S Central Ave
Palos Heights, IL 60463-2601

Phone

(708) 597-1000

Fax

(708) 597-1000

NPI assigned

Jun 1, 2005

Last updated

Sep 23, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Johanna R Zandstra

Title

Compliance Officer

Phone

(708) 342-8137

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Providence Palos Heights Doing business as

Member of 1

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

• Rest Haven Illiana Christian Convalescent Home

  dba Providence Hospice

  • Community Based Hospice Care Agency
  • Homer Glen, IL
  • NPI 1407855562

  Member Of

  NPD member

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Victoria Reid, PHD

  • Clinical Psychologist
  • Orland Park, IL
  • NPI 1922131622
  NPD (past)

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

{
    "created_epoch": "1117584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442966400000",
    "number": "1174525422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18601 N CREEK DR",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604776397",
            "telephone_number": "708-342-8100",
            "fax_number": "708-342-8006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13259 S CENTRAL AVE",
            "city": "PALOS HEIGHTS",
            "state": "IL",
            "postal_code": "604632601",
            "telephone_number": "708-597-1000",
            "fax_number": "708-597-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE OPERATIONS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-01",
        "last_updated": "2015-09-23",
        "status": "A",
        "authorized_official_last_name": "ZANDSTRA",
        "authorized_official_first_name": "JOHANNA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "COMPLIANCE OFFICER",
        "authorized_official_telephone_number": "708-342-8137",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "0028605",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "362382853002",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Palos Heights",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Palos Heights, IL
• Providers in Palos Heights, IL by specialty
• Skilled Nursing Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2015; 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.