Healthcare Provider Details

I. General information

NPI: 1588036891
Provider Name (Legal Business Name): SKOKIE SKILLED NURSING FACILITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2015
Last Update Date: 10/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 LAVERGNE AVE
SKOKIE IL
60077-1618
US

IV. Provider business mailing address

7040 N RIDGEWAY AVE
LINCOLNWOOD IL
60712-2620
US

V. Phone/Fax

Practice location:
  • Phone: 847-679-2322
  • Fax: 847-679-9325
Mailing address:
  • Phone: 847-679-9797
  • Fax: 847-676-5348

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: YAIR ZUCKERMAN
Title or Position: CEO
Credential:
Phone: 847-679-9797