| NPI | 1851795686 |
|---|---|
| Doing Business As | PROVIDENCE PAVILION |
| Entity Type | Organization |
| Authorized Contact | BENJAMIN KLEIN Manager 847-329-4100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility |
| Enumeration Date | 2014-10-22 |
| Last Update Date | 2014-10-22 |