Healthcare Provider Details

I. General information

NPI: 1538153374
Provider Name (Legal Business Name): LEXINGTON HEALTH CARE CENTER OF CHICAGO RIDGE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10300 SOUTHWEST HWY
CHICAGO RIDGE IL
60415-1426
US

IV. Provider business mailing address

665 W NORTH AVE SUITE 500
LOMBARD IL
60148-1134
US

V. Phone/Fax

Practice location:
  • Phone: 708-425-1100
  • Fax: 708-425-0779
Mailing address:
  • Phone: 630-458-4700
  • Fax: 630-458-4770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number0042739
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0042739
License Number StateIL

VIII. Authorized Official

Name: MS. SUSAN ROJEK
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CPA
Phone: 630-458-4780