NPIMap

Organization Active NPI

Imperial of Hazel Crest

  • Skilled Nursing Facility
  • Hazel Crest, IL
National Provider Identifier
1376744250
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
0040402 Issued in IL
Legal business name
IMPERIAL OF HAZEL CREST
Practice address
3300 175TH St
Hazel Crest, IL 60429-1604
Phone
(708) 335-2400
Fax
(708) 335-1825
NPI assigned
May 30, 2007
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
Ms. Marcita Carter
Title
Administrator
Phone
(708) 335-2400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 0040402 IL Primary

Addresses

Primary practice location

3300 175TH St
Hazel Crest, IL 60429-1604

Mailing address

3300 175TH St
Hazel Crest, IL 60429-1604
Phone (708) 335-2400

Other identifiers 1

IdentifierTypeStateIssuer
0040402MedicaidIL

National Provider Directory

National Provider Directory
Tax ID family
Careplus Management2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1376744250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 175TH ST",
            "city": "HAZEL CREST",
            "state": "IL",
            "postal_code": "604291604",
            "telephone_number": "708-335-2400",
            "fax_number": "708-335-1825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 175TH ST",
            "city": "HAZEL CREST",
            "state": "IL",
            "postal_code": "604291604",
            "telephone_number": "708-335-2400",
            "fax_number": "708-335-1825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPERIAL OF HAZEL CREST",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CARTER",
        "authorized_official_first_name": "MARCITA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "708-335-2400",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "0040402",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0040402",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hazel Crest, 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.