Healthcare Provider Details

I. General information

NPI: 1396629903
Provider Name (Legal Business Name): PARK RIDGE SKILLED NURSING FACILITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 N GREENWOOD AVE
PARK RIDGE IL
60068-2054
US

IV. Provider business mailing address

3450 OAKTON ST
SKOKIE IL
60076-2951
US

V. Phone/Fax

Practice location:
  • Phone: 847-692-5600
  • Fax:
Mailing address:
  • Phone: 773-844-8880
  • Fax:

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: MENACHEM SHABAT
Title or Position: MEDICARE AUTHORIZED OFFICIAL
Credential:
Phone: 773-848-4949