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General NPI Number Information
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NPI Number | 1619796356
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Entity Type | Organization
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Legal Business Name | SOUTH ELGIN LIVING & REHAB CENTER LLC
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Dates
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Enumeration Date | 10/09/2024
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 746 W SPRING ST
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City | SOUTH ELGIN
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State | IL
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Zip | 60177-1424
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Country | US
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Telephone | 847-679-2121
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Fax |
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Provider Business Mailing Address
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Address Line | 3737 W ARTHUR AVE
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City | LINCOLNWOOD
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State | IL
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Zip | 60712-4029
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Country | US
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Telephone | 847-679-2121
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | EPHRAIM BRAUNSTEIN
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Credential |
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Telephone | 847-679-2121
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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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Taxonomy #2
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number |
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License Number State |
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