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General NPI Number Information
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NPI Number | 1992094205
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Entity Type | Organization
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Legal Business Name | LINCOLNSHIRE SENIOR CARE LLC
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Dates
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Enumeration Date | 04/07/2011
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Last Update Date | 07/03/2018
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Provider Practice Location Address
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Address Line | 960 AUDUBON WAY
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City | LINCOLNSHIRE
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State | IL
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Zip | 60069
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Country | US
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Telephone | 847-876-2401
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Fax |
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Provider Business Mailing Address
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Address Line | 800 AUDUBON WAY
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City | LINCOLNSHIRE
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State | IL
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Zip | 60069-3811
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Country | US
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Telephone | 847-876-2401
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Fax |
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Authorized Official
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Title or Position | CEO & PRESIDENT
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Name | DAVID A REIS
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Credential |
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Telephone | 203-222-6262
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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 | 0051219
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License Number State | IL
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