MEDICARE: LENA LIVING CENTER, 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	0047746	IL

General Provider Information

NPI Number	:	1255358198
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LENA LIVING CENTER, LLC

Provider Business Mailing Address
First Line	:	1010 S LOGAN ST
Second Line	:
City	:	LENA
State	:	IL
Zip	:	61048-9566
Country	:	US
Telephone Number	:	815-369-4561
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 S LOGAN ST
Second Line	:
City	:	LENA
State	:	IL
Zip	:	61048-9566
Country	:	US
Telephone Number	:	815-369-4561
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SUZANNE KOENIG
Credential	:
Telephone Number	:	773-202-0000

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	04/20/2008

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