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General NPI Number Information
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NPI Number | 1972361731
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Entity Type | Organization
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Legal Business Name | FULLERTON SKILLED NURSING FACILITY LLC
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Dates
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Enumeration Date | 03/07/2024
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Last Update Date | 03/07/2024
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Provider Practice Location Address
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Address Line | 1366 W FULLERTON AVE
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City | CHICAGO
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State | IL
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Zip | 60614-2129
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Country | US
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Telephone | 773-844-8880
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Fax |
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Provider Business Mailing Address
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Address Line | 3450 OAKTON ST
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City | SKOKIE
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State | IL
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Zip | 60076-2951
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Country | US
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Telephone | 773-844-8880
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MENACHEM SHABAT
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Credential |
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Telephone | 847-679-5331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number |
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License Number State |
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