Healthcare Provider Details

I. General information

NPI: 1528630837
Provider Name (Legal Business Name): LIEBERMAN SKILLED NURSING FACILITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2021
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9700 GROSS POINT RD
SKOKIE IL
60076-1175
US

IV. Provider business mailing address

3450 OAKTON ST
SKOKIE IL
60076-2951
US

V. Phone/Fax

Practice location:
  • Phone: 847-674-7210
  • Fax: 847-674-6366
Mailing address:
  • Phone: 847-745-7000
  • 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: DANIEL GARDEN
Title or Position: MBR
Credential:
Phone: 847-745-7000