Bloomingdale Pavilion, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

44347 Issued in IL

Legal business name

BLOOMINGDALE PAVILION, LLC

Practice address

311 Edgewater Dr
Bloomingdale, IL 60108-1979

Phone

(630) 894-7400

Fax

(630) 894-8528

NPI assigned

Sep 30, 2005

Last updated

Aug 22, 2020By 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. Josephine Solis, L.P.N.

Title

MDS/Care Plan Coordinator

Phone

(630) 894-7400

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1128038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1881681245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 EDGEWATER DR",
            "city": "BLOOMINGDALE",
            "state": "IL",
            "postal_code": "601081979",
            "telephone_number": "630-894-7400",
            "fax_number": "630-894-8528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 EDGEWATER DR",
            "city": "BLOOMINGDALE",
            "state": "IL",
            "postal_code": "601081979",
            "telephone_number": "630-894-7400",
            "fax_number": "630-894-8528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOMINGDALE PAVILION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SOLIS",
        "authorized_official_first_name": "JOSEPHINE",
        "authorized_official_title_or_position": "MDS/CARE PLAN COORDINATOR",
        "authorized_official_telephone_number": "630-894-7400",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "L.P.N."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "44347",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in Bloomingdale, IL
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• Skilled Nursing Facility in Illinois

• 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.