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NPI Code Detail

MEDICARE: SHERIDAN VILLAGE NURSING AND REHABILITATION CENTER LLC

MEDICARE: SHERIDAN VILLAGE 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
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1801432711
Entity Type Code : Organization
Provider Name (Legal Business Name) : SHERIDAN VILLAGE NURSING AND REHABILITATION CENTER LLC
Provider Business Mailing Address
First Line : 8707 SKOKIE BLVD STE 109
Second Line :
City : SKOKIE
State : IL
Zip : 60077-2200
Country : US
Telephone Number : 312-791-0035
Fax Number :
Provider Business Practice Location Address
First Line : 5838 N SHERIDAN RD
Second Line :
City : CHICAGO
State : IL
Zip : 60660-4916
Country : US
Telephone Number : 773-769-2230
Fax Number :
Authorized Official
Title or Position : OWNER
Name : YECHIEL MASHIACH
Credential :
Telephone Number : 312-791-0035
Provider Enumeration Date : 11/26/2019
Last Update Date : 11/26/2019

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