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General NPI Number Information
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NPI Number | 1295805521
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Entity Type | Organization
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Legal Business Name | LAKEVIEW NURSING AND REHABILITATION CENTRE INC
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 735 WEST DIVERSEY PARKWAY
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City | CHICAGO
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State | IL
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Zip | 60614-2337
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Country | US
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Telephone | 773-348-4055
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Fax | 773-348-6259
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Provider Business Mailing Address
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Address Line | 735 WEST DIVERSEY PARKWAY
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City | CHICAGO
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State | IL
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Zip | 60614-2337
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Country | US
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Telephone | 773-348-4055
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Fax | 773-348-6259
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Authorized Official
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Title or Position | PRESIDENT 50 PERCENT OWNER
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Name | MR. SAM BOREK
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Credential |
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Telephone | 847-256-7600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 1764042
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License Number State | IL
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