Provider Demographics
NPI:1447224423
Name:OREGON HEALTHCARE CENTER
Entity type:Organization
Organization Name:OREGON HEALTHCARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:MOE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-982-2300
Mailing Address - Street 1:7434 SKOKIE BLVD
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-3341
Mailing Address - Country:US
Mailing Address - Phone:847-982-2300
Mailing Address - Fax:847-982-2304
Practice Address - Street 1:811 S 10TH ST
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:IL
Practice Address - Zip Code:61061-2129
Practice Address - Country:US
Practice Address - Phone:815-732-7994
Practice Address - Fax:815-732-7998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0037838314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
145476Medicare Oscar/Certification
IL14-5476Medicare ID - Type Unspecified