Healthcare Provider Details

I. General information

NPI: 1255358198
Provider Name (Legal Business Name): LENA LIVING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 S LOGAN ST
LENA IL
61048-9566
US

IV. Provider business mailing address

1010 S LOGAN ST
LENA IL
61048-9566
US

V. Phone/Fax

Practice location:
  • Phone: 815-369-4561
  • Fax:
Mailing address:
  • Phone: 815-369-4561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0047746
License Number StateIL

VIII. Authorized Official

Name: SUZANNE KOENIG
Title or Position: PRESIDENT
Credential:
Phone: 773-202-0000