Healthcare Provider Details

I. General information

NPI: 1801432711
Provider Name (Legal Business Name): SHERIDAN VILLAGE NURSING AND REHABILITATION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2019
Last Update Date: 11/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5838 N SHERIDAN RD
CHICAGO IL
60660-4916
US

IV. Provider business mailing address

8707 SKOKIE BLVD STE 109
SKOKIE IL
60077-2200
US

V. Phone/Fax

Practice location:
  • Phone: 773-769-2230
  • Fax:
Mailing address:
  • Phone: 312-791-0035
  • Fax:

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: YECHIEL MASHIACH
Title or Position: OWNER
Credential:
Phone: 312-791-0035