NPIMap

Organization Active NPI

Arbor of Itasca, Inc

  • Skilled Nursing Facility
  • Itasca, IL
National Provider Identifier
1528128204
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
0019471 Issued in IL
Legal business name
ARBOR OF ITASCA, INC
Practice address
535 South Elm Street
Itasca, IL 60143-2187
Phone
(630) 773-9416
Fax
(630) 773-9434
NPI assigned
Dec 11, 2006
Last updated
Aug 22, 2020By the provider in NPPES
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
Thomas Annarella, LNHA
Title
Administrator
Phone
(630) 773-9416

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 0019471 IL Primary

Addresses

Primary practice location

535 South Elm Street
Itasca, IL 60143-2187

Mailing address

535 S Elm St
Itasca, IL 60143-2187
Phone (630) 773-9416

Other identifiers 1

IdentifierTypeStateIssuer
0019471MedicaidIL

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1528128204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "535 S ELM ST",
            "city": "ITASCA",
            "state": "IL",
            "postal_code": "601432187",
            "telephone_number": "630-773-9416",
            "fax_number": "630-773-9434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "535 SOUTH ELM STREET",
            "city": "ITASCA",
            "state": "IL",
            "postal_code": "601432187",
            "telephone_number": "630-773-9416",
            "fax_number": "630-773-9434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARBOR OF ITASCA, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ANNARELLA",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "630-773-9416",
        "authorized_official_credential": "LNHA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "0019471",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0019471",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Itasca, 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.