Healthcare Provider Details

I. General information

NPI: 1588353114
Provider Name (Legal Business Name): LINCOLN PARK SUPPORTIVE LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 05/01/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2437 N SOUTHPORT AVE
CHICAGO IL
60614-2060
US

IV. Provider business mailing address

3450 OAKTON ST
SKOKIE IL
60076-2951
US

V. Phone/Fax

Practice location:
  • Phone: 773-472-8400
  • Fax:
Mailing address:
  • Phone: 847-679-9797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: CHAIM RAJCHENBACH
Title or Position: CEO
Credential:
Phone: 847-679-9797