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ABBOTT HOUSE LLC NPI 1194859892


NPI Information

NPI: 1194859892
Provider Name: ABBOTT HOUSE, LLC
Classification: Intermediate Care Facility, Mental Illness - 310500000X
Entity Type: Organization

CLIA Number: 14D0669365

Address:
405 CENTRAL AVE
HIGHLAND PARK, IL
ZIP 60035
Phone: (847) 432-6080
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ABBOTT HOUSE, LLC is an intermediate care facility mental illness in Highland Park, IL. The provider is a nursing facility that provides an intermediate level of nursing care to individuals whose functional abilities are significantly compromise by mental illness. ABBOTT HOUSE, LLC NPI is 1194859892. The provider is registered as an organization entity type.

The provider's business location address is:

405 CENTRAL AVE
HIGHLAND PARK, IL
ZIP 60035-622
Phone: (847) 432-6080
Fax: (847) 432-7286

The provider's authorized official is Ivy K Fishman .
The authorized official title is Administrator and has the following contact phone number (847) 432-6080.

The CLIA number assigned to this NPI record is 14D0669365 - other - care facility f ment-hill with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/15/2007 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1310500000XIntermediate Care Facility, Mental Illness0023739ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
10023739OTHERILLINOISPUBLIC HEALTH LICENSE NUM

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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