Healthcare Provider Details

I. General information

NPI: 1811987951
Provider Name (Legal Business Name): LEBANON NURSING & REHABILITATION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 OREGONIA RD
LEBANON OH
45036-1983
US

IV. Provider business mailing address

6600 N SAINT LOUIS AVE
LINCOLNWOOD IL
60712-3726
US

V. Phone/Fax

Practice location:
  • Phone: 513-932-1121
  • Fax: 513-934-0899
Mailing address:
  • Phone: 847-677-9823
  • Fax: 847-677-9837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1619-NH
License Number StateOH

VIII. Authorized Official

Name: MR. LEO FEIGENBAUM
Title or Position: CEO
Credential:
Phone: 847-677-9823