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NPI Code Detail

MEDICARE: GROVE AT THE LAKE LIVING AND REHABILITATION CENTER LLC

MEDICARE: GROVE AT THE LAKE LIVING AND REHABILITATION 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
1314000000XSkilled Nursing Facility2019775IL

General Provider Information

NPI Number : 1396024964
Entity Type Code : Organization
Provider Name (Legal Business Name) : GROVE AT THE LAKE LIVING AND REHABILITATION CENTER 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 :
Provider Business Practice Location Address
First Line : 2534 ELIM AVE
Second Line :
City : ZION
State : IL
Zip : 60099-2661
Country : US
Telephone Number : 847-746-8435
Fax Number :
Authorized Official
Title or Position : AR MANAGER
Name : REUVEN LEVITIN
Credential :
Telephone Number : 847-676-5307
Provider Enumeration Date : 08/12/2011
Last Update Date : 08/12/2011

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Directions to “GROVE AT THE LAKE LIVING AND REHABILITATION CENTER LLC ” Practice Location

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