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General NPI Number Information
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NPI Number | 1568413821
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Entity Type | Organization
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Legal Business Name | WAUKEGAN TERRACE
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 919 WASHINGTON PARK
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City | WAUKEGAN
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State | IL
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Zip | 60085-7258
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Country | US
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Telephone | 847-623-9100
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Fax | 847-623-9179
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Provider Business Mailing Address
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Address Line | 5151 CHURCH ST
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City | SKOKIE
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State | IL
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Zip | 60077-1123
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Country | US
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Telephone | 847-933-9200
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Fax | 847-674-5794
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Authorized Official
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Title or Position | CFO
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Name | MR. AVRUM WEINFELD
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Credential |
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Telephone | 847-674-5795
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 0027052
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 310500000X
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Taxonomy Name | Mental Illness Intermediate Care Facility
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License Number |
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License Number State |
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