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NPI Code Detail

MEDICARE: LEXINGTON HEALTH CARE CENTER OF CHICAGO RIDGE, INC.

MEDICARE: LEXINGTON HEALTH CARE CENTER OF CHICAGO RIDGE, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332BP3500XParenteral & Enteral Nutrition Supplies (DME)0042739IL

General Provider Information

NPI Number : 1124142278
Entity Type Code : Organization
Provider Name (Legal Business Name) : LEXINGTON HEALTH CARE CENTER OF CHICAGO RIDGE, INC.
Provider Business Mailing Address
First Line : 665 W NORTH AVE
Second Line : SUITE 500
City : LOMBARD
State : IL
Zip : 60148-1134
Country : US
Telephone Number : 630-458-4700
Fax Number : 630-458-4770
Provider Business Practice Location Address
First Line : 10300 SOUTHWEST HWY
Second Line :
City : CHICAGO RIDGE
State : IL
Zip : 60415-1426
Country : US
Telephone Number : 708-425-1100
Fax Number : 708-425-0779
Authorized Official
Title or Position : PRESIDENT
Name : MR. JOHN SAMATAS
Credential :
Telephone Number : 630-458-4700
Provider Enumeration Date : 03/16/2007
Last Update Date : 10/17/2008

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