Healthcare Provider Details

I. General information

NPI: 1376830992
Provider Name (Legal Business Name): LEXINGTON HEALTH CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2011
Last Update Date: 07/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 S FINLEY RD
LOMBARD IL
60148-4830
US

IV. Provider business mailing address

2100 S FINLEY RD
LOMBARD IL
60148-4830
US

V. Phone/Fax

Practice location:
  • Phone: 630-495-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number056.005763
License Number StateIL

VIII. Authorized Official

Name: MR. MATT MROWIEC
Title or Position: COMPLIANCE COORDINATOR
Credential:
Phone: 435-776-7279