MEDICARE: KENSINGTON PLACE NURSING AND REHABILITATION CENTER LLC

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
1	313M00000X	Nursing Facility/Intermediate Care Facility		IL
2	314000000X	Skilled Nursing Facility	0050716	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437471075
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENSINGTON PLACE NURSING AND REHABILITATION CENTER LLC

Provider Business Mailing Address
First Line	:	3405 S MICHIGAN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-3819
Country	:	US
Telephone Number	:	312-791-0035
Fax Number	:	312-791-0626

Provider Business Practice Location Address
First Line	:	3405 S MICHIGAN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-3819
Country	:	US
Telephone Number	:	312-791-0035
Fax Number	:	312-791-0626

Authorized Official
Title or Position	:	MANAGER
Name	:	YECHIEL MASHIACH
Credential	:
Telephone Number	:	847-905-4000

Provider Enumeration Date	:	02/24/2010
Last Update Date	:	05/13/2019

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