Organization Name: | VANDALIA TERRACE, LTD |
NPI Number: | 1851359871 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BYRON WITT (ADMINISTRATOR) |
Mailing Address: | 3845 Oakton St Skokie |
State: | IL US |
Postal Code: | 600763429 |
Phone Number: | 8476790100 |
Fax Number: | 8476790673 |
NPI Enumeration Date: | 05/01/2006 |
NPI Last Update Date: | 04/20/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 310500000X |
License Number: | 1687983 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Nursing & Custodial Care Facilities |
Taxonomy Classification: | Intermediate Care Facility, Mental Illness |
Taxonomy Specialization: | |
Taxonomy Definition: | A nursing facility that provides an intermediate level of nursing care to individuals whose functional abilities are significantly compromise by mental illness. |