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NPI Code Detail

MEDICARE: LINCOLN PARK TERRACE, INC.

MEDICARE: LINCOLN PARK TERRACE, 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
1314000000XSkilled Nursing Facility0026203IL

General Provider Information

NPI Number : 1417083270
Entity Type Code : Organization
Provider Name (Legal Business Name) : LINCOLN PARK TERRACE, INC.
Provider Business Mailing Address
First Line : 2732 N HAMPDEN CT
Second Line :
City : CHICAGO
State : IL
Zip : 60614-1612
Country : US
Telephone Number : 177-324-8600
Fax Number : 177-327-8970
Provider Business Practice Location Address
First Line : 2732 N HAMPDEN CT
Second Line :
City : CHICAGO
State : IL
Zip : 60614-1612
Country : US
Telephone Number : 177-324-8600
Fax Number : 177-327-8970
Authorized Official
Title or Position : ADMINISTRATOR
Name : MR. DOV SOLOMON
Credential :
Telephone Number : 773-248-6000
Provider Enumeration Date : 02/26/2007
Last Update Date : 08/22/2020

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