Healthcare Provider Details

I. General information

NPI: 1659624112
Provider Name (Legal Business Name): GROVE OF NORTHBROOK LIVING & REHAB CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2012
Last Update Date: 10/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 SKOKIE BLVD
NORTHBROOK IL
60062-1611
US

IV. Provider business mailing address

7040 N RIDGEWAY AVE
LINCOLNWOOD IL
60712-2620
US

V. Phone/Fax

Practice location:
  • Phone: 847-564-0505
  • Fax:
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: REUVEN LEVITIN
Title or Position: AR MANAGER
Credential:
Phone: 847-676-5342