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General NPI Number Information
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NPI Number | 1306201009
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Entity Type | Organization
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Legal Business Name | TRANSITIONAL CARE OF LAKE COUNTY, LLC
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Dates
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Enumeration Date | 12/22/2015
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Last Update Date | 10/11/2021
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Provider Practice Location Address
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Address Line | 850 E US HIGHWAY 45
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City | MUNDELEIN
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State | IL
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Zip | 60060-4612
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Country | US
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Telephone | 847-377-7200
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Fax | 480-436-5749
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Provider Business Mailing Address
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Address Line | 5 REVERE DR STE 200
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City | NORTHBROOK
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State | IL
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Zip | 60062-8000
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Country | US
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Telephone | 847-377-7200
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Fax | 480-436-5749
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Authorized Official
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Title or Position | MANAGER
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Name | BRAD HABER
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Credential |
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Telephone | 312-982-1717
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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 | 0054049
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License Number State | IL
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