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NPI Code Detail

MEDICARE: THE GROVE AT LINCOLN PARK LIVING & REHAB CENTER, LLC

MEDICARE: THE GROVE AT LINCOLN PARK LIVING & REHAB 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 Facility

General Provider Information

NPI Number : 1508014564
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE GROVE AT LINCOLN PARK LIVING & REHAB CENTER, LLC
Provider Business Mailing Address
First Line : 2732 N HAMPDEN CT
Second Line :
City : CHICAGO
State : IL
Zip : 60614-1612
Country : US
Telephone Number : 773-248-6000
Fax Number : 773-248-9703
Provider Business Practice Location Address
First Line : 2732 N HAMPDEN CT
Second Line :
City : CHICAGO
State : IL
Zip : 60614-1612
Country : US
Telephone Number : 773-248-6000
Fax Number : 773-248-9703
Authorized Official
Title or Position : COMTROLLER
Name : MR. REUVEN LEVITIN
Credential :
Telephone Number : 847-676-5342
Provider Enumeration Date : 09/03/2008
Last Update Date : 01/25/2016

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