MEDICARE: LEXINGTON HEALTH CARE CENTER OF BLOOMINGDALE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	313M00000X	Nursing Facility/Intermediate Care Facility	0035188	IL
2	314000000X	Skilled Nursing Facility	0035188	IL

General Provider Information

NPI Number	:	1003800830
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEXINGTON HEALTH CARE CENTER OF BLOOMINGDALE INC

Provider Business Mailing Address
First Line	:	665 W NORTH AVE
Second Line	:	STE 500
City	:	LOMBARD
State	:	IL
Zip	:	60148-1134
Country	:	US
Telephone Number	:	630-458-4700
Fax Number	:	630-458-4770

Provider Business Practice Location Address
First Line	:	165 S BLOOMINGDALE RD
Second Line	:
City	:	BLOOMINGDALE
State	:	IL
Zip	:	60108-1434
Country	:	US
Telephone Number	:	630-980-8700
Fax Number	:	630-980-6170

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOHN SAMATAS
Credential	:
Telephone Number	:	630-458-4700

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	09/22/2021

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