Basic Information
| Provider Information | |||||||||
| NPI: | 1548627755 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST GEORGE SKILLED NURSING FACILITY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3450 OAKTON ST | ||||||||
| Address2: | |||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600762951 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476799797 | ||||||||
| FaxNumber: | 8476765348 | ||||||||
| Practice Location | |||||||||
| Address1: | 178 S 1200 E | ||||||||
| Address2: | |||||||||
| City: | SAINT GEORGE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 847905508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4356881207 | ||||||||
| FaxNumber: | 4356888650 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2016 | ||||||||
| LastUpdateDate: | 01/19/2016 | ||||||||
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| AuthorizedOfficialLastName: | ZUCKERMAN | ||||||||
| AuthorizedOfficialFirstName: | YAIR | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8476799797 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.