Basic Information
| Provider Information | |||||||||
| NPI: | 1831275999 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EASTGATE MANOR OF ALGONQUIN LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 665 WEST NORTH AVENUE SUITE 500 | ||||||||
| Address2: | |||||||||
| City: | LOMBARD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6304584700 | ||||||||
| FaxNumber: | 6304584770 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 EASTGATE COURT | ||||||||
| Address2: | |||||||||
| City: | ALGONQUIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8474582800 | ||||||||
| FaxNumber: | 8474580017 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SAMATAS | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 6304584700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 311Z00000X | Y | Nursing & Custodial Care Facilities | Custodial Care Facility |
No ID Information.