Healthcare Provider Details

I. General information

NPI: 1942294780
Provider Name (Legal Business Name): LEXINGTON HEALTH CARE CENTER OF LAGRANGE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4735 WILLOW SPRINGS RD
LA GRANGE IL
60525-6130
US

IV. Provider business mailing address

665 W NORTH AVE SUITE 500
LOMBARD IL
60148-1134
US

V. Phone/Fax

Practice location:
  • Phone: 708-352-6900
  • Fax: 708-482-0239
Mailing address:
  • Phone: 630-458-4700
  • Fax: 630-458-4770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number0038083
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0038083
License Number StateIL

VIII. Authorized Official

Name: MR. JOHN SAMATAS
Title or Position: PRESIDENT
Credential:
Phone: 630-458-4700