Healthcare Provider Details

I. General information

NPI: 1619796356
Provider Name (Legal Business Name): SOUTH ELGIN LIVING & REHAB CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2024
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

746 W SPRING ST
SOUTH ELGIN IL
60177-1424
US

IV. Provider business mailing address

3737 W ARTHUR AVE
LINCOLNWOOD IL
60712-4029
US

V. Phone/Fax

Practice location:
  • Phone: 847-679-2121
  • Fax:
Mailing address:
  • Phone: 847-679-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: EPHRAIM BRAUNSTEIN
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 847-679-2121