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General NPI Number Information
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NPI Number | 1336504117
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Entity Type | Organization
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Legal Business Name | LAKE FOREST PLACE, LLC
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Dates
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Enumeration Date | 12/22/2015
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Last Update Date | 10/08/2021
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Provider Practice Location Address
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Address Line | 1100 PEMBRIDGE DR
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City | LAKE FOREST
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State | IL
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Zip | 60045-4228
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Country | US
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Telephone | 847-604-6700
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Fax | 847-979-3969
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Provider Business Mailing Address
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Address Line | 1100 PEMBRIDGE DR
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City | LAKE FOREST
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State | IL
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Zip | 60045-4228
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Country | US
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Telephone | 847-437-6700
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Fax | 847-316-8723
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MARK HAVRILKA
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Credential |
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Telephone | 847-979-3904
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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 |
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License Number State |
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