Healthcare Provider Details

I. General information

NPI: 1669055943
Provider Name (Legal Business Name): LAKE ZURICH SKILLED NURSING FACILITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2021
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S RAND RD
LAKE ZURICH IL
60047-2450
US

IV. Provider business mailing address

3450 OAKTON ST
SKOKIE IL
60076-2951
US

V. Phone/Fax

Practice location:
  • Phone: 847-726-1200
  • Fax: 847-726-1265
Mailing address:
  • Phone: 847-679-9797
  • Fax: 847-679-1126

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: MORDECHAY NINIO
Title or Position: CFO
Credential:
Phone: 847-676-5315