Healthcare Provider Details

I. General information

NPI: 1639178544
Provider Name (Legal Business Name): SKOKIE MEADOW NURSING CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9615 N KNOX AVE
SKOKIE IL
60076-1219
US

IV. Provider business mailing address

9615 N KNOX AVE
SKOKIE IL
60076-1219
US

V. Phone/Fax

Practice location:
  • Phone: 847-679-4161
  • Fax: 847-679-3241
Mailing address:
  • Phone: 847-679-4161
  • Fax: 847-679-3241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0031385
License Number StateIL

VIII. Authorized Official

Name: MR. MARK APPEL
Title or Position: CONTROLLER
Credential:
Phone: 847-679-4161