Healthcare Provider Details

I. General information

NPI: 1023315421
Provider Name (Legal Business Name): CRG LYNWOOD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2011
Last Update Date: 12/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 KIMOLE LN
ADRIAN MI
49221-1463
US

IV. Provider business mailing address

4711 GOLF RD SUITE 200
SKOKIE IL
60076-1224
US

V. Phone/Fax

Practice location:
  • Phone: 517-263-6771
  • Fax: 517-265-8599
Mailing address:
  • Phone: 847-933-9280
  • 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: ABRAHAM GUTNICKI
Title or Position: MEMBER
Credential:
Phone: 847-933-9280