Pavilion of Waukegan, II, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0036467 Issued in IL

Legal business name

PAVILION OF WAUKEGAN, II, INC.

Practice address

2217 Washington St
Waukegan, IL 60085-5060

Phone

(847) 997-1750

Fax

(773) 478-0320

NPI assigned

Feb 27, 2007

Organization subpart

No

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

Authorized official

Name

Ms. Nancy C Masoni

Title

Director of Finance

Phone

(847) 997-1750

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1233705600000",
    "number": "1437286309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6350 N AVERS AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606591029",
            "telephone_number": "847-997-1750",
            "fax_number": "773-478-0320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2217 WASHINGTON ST",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600855060",
            "telephone_number": "847-997-1750",
            "fax_number": "773-478-0320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAVILION OF WAUKEGAN, II, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-27",
        "last_updated": "2009-02-04",
        "status": "A",
        "authorized_official_last_name": "MASONI",
        "authorized_official_first_name": "NANCY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "847-997-1750",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "0036467",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF IL INSURANCE",
            "identifier": "1167",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Devi Ketankumar Patel
• Krina D Patel, RN, MSN, APRN
• Pratibha B Patel, DPM
• Rina Navinchandra Patel, D.D.S
• Joanne J Patterson
• Pavilion of Waukegan, LLC
• James Pawlik, DDS
• Pearle Vision
• Joshua Pechter
• Sharon Jean Peddicord, LCSW

• Skilled Nursing Facility in Waukegan, IL
• Providers in Waukegan, 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 Feb 4, 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.