Healthcare Provider Details

I. General information

NPI: 1225585987
Provider Name (Legal Business Name): SOUTH LOOP SKILLED NURSING FACILITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2016
Last Update Date: 09/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 S WABASH AVE
CHICAGO IL
60616-1219
US

IV. Provider business mailing address

3450 OAKTON ST
SKOKIE IL
60076-2951
US

V. Phone/Fax

Practice location:
  • Phone: 312-922-2777
  • Fax: 312-939-1820
Mailing address:
  • Phone: 847-679-9797
  • Fax: 847-676-5348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: YAIR ZUKERMAN
Title or Position: CEO
Credential:
Phone: 847-679-9797