MEDICARE: RIVIERA CARE 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	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1669639407
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVIERA CARE CENTER, LLC

Provider Business Mailing Address
First Line	:	3505 HOWARD ST
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60076-4012
Country	:	US
Telephone Number	:	847-673-6767
Fax Number	:	847-673-6768

Provider Business Practice Location Address
First Line	:	490 W 16TH PL
Second Line	:
City	:	CHICAGO HEIGHTS
State	:	IL
Zip	:	60411-3224
Country	:	US
Telephone Number	:	708-481-4444
Fax Number	:	708-481-4606

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. YOSEF MEYSTEL
Credential	:
Telephone Number	:	847-673-6767

Provider Enumeration Date	:	05/20/2008
Last Update Date	:	05/20/2008

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