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NPI Code Detail

MEDICARE: LAKE COOK TERRACE NURSING CENTER

MEDICARE: LAKE COOK TERRACE NURSING CENTER
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 Facility1773151IL

General Provider Information

NPI Number : 1942344007
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAKE COOK TERRACE NURSING CENTER
Provider Business Mailing Address
First Line : 263 SKOKIE BLVD
Second Line :
City : NORTHBROOK
State : IL
Zip : 60062-1611
Country : US
Telephone Number : 847-564-0505
Fax Number : 847-564-3775
Provider Business Practice Location Address
First Line : 263 SKOKIE BLVD
Second Line :
City : NORTHBROOK
State : IL
Zip : 60062-1611
Country : US
Telephone Number : 847-564-0505
Fax Number : 847-564-3775
Authorized Official
Title or Position : ADMINISTRATOR
Name : MRS. SHELLEY MARTINEZ
Credential :
Telephone Number : 847-564-0505
Provider Enumeration Date : 02/20/2007
Last Update Date : 08/22/2020

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Directions to “LAKE COOK TERRACE NURSING CENTER ” Practice Location

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