MEDICARE: ASTORIA PLACE SKILLED NURSING FACILITY LLC

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	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1053783407
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASTORIA PLACE SKILLED NURSING FACILITY LLC

Provider Business Mailing Address
First Line	:	7040 N RIDGEWAY AVE
Second Line	:
City	:	LINCOLNWOOD
State	:	IL
Zip	:	60712-2620
Country	:	US
Telephone Number	:	847-679-9797
Fax Number	:	847-676-5348

Provider Business Practice Location Address
First Line	:	6300 N CALIFORNIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-1702
Country	:	US
Telephone Number	:	773-973-1900
Fax Number	:	773-973-1904

Authorized Official
Title or Position	:	CEO
Name	:	YAIR ZUCKERMAN
Credential	:
Telephone Number	:	847-679-9797

Provider Enumeration Date	:	10/26/2015
Last Update Date	:	10/26/2015

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