Healthcare Provider Details

I. General information

NPI: 1295805521
Provider Name (Legal Business Name): LAKEVIEW NURSING AND REHABILITATION CENTRE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 WEST DIVERSEY PARKWAY
CHICAGO IL
60614-2337
US

IV. Provider business mailing address

735 WEST DIVERSEY PARKWAY
CHICAGO IL
60614-2337
US

V. Phone/Fax

Practice location:
  • Phone: 773-348-4055
  • Fax: 773-348-6259
Mailing address:
  • Phone: 773-348-4055
  • Fax: 773-348-6259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1764042
License Number StateIL

VIII. Authorized Official

Name: MR. SAM BOREK
Title or Position: PRESIDENT 50 PERCENT OWNER
Credential:
Phone: 847-256-7600