Healthcare Provider Details

I. General information

NPI: 1407980113
Provider Name (Legal Business Name): LAKEFRONT NURSING AND REHABILITATION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7618 N SHERIDAN RD
CHICAGO IL
60626-1418
US

IV. Provider business mailing address

7618 N SHERIDAN RD
CHICAGO IL
60626-1418
US

V. Phone/Fax

Practice location:
  • Phone: 773-743-7711
  • Fax: 773-761-3387
Mailing address:
  • Phone: 773-743-7711
  • Fax: 773-761-3387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1738852
License Number StateIL

VIII. Authorized Official

Name: MR. MENACHEM SHABAT
Title or Position: OWNER
Credential:
Phone: 773-743-7711