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General NPI Number Information
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NPI Number | 1477931756
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Entity Type | Organization
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Legal Business Name | VILLA AT LINCOLN PARK, LLC
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Dates
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Enumeration Date | 05/07/2015
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Last Update Date | 01/19/2023
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Provider Practice Location Address
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Address Line | 1700 C A BECKER DR
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City | RACINE
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State | WI
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Zip | 53406-4714
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Country | US
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Telephone | 847-440-2660
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Fax | 847-701-3308
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Provider Business Mailing Address
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Address Line | 3701 W LUNT AVE
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City | LINCOLNWOOD
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State | IL
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Zip | 60712-2615
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Country | US
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Telephone | 847-440-2660
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | BENJAMIN ISRAEL
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Credential |
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Telephone | 847-440-2660
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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 | 2269
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License Number State | WI
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