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NPI Code Detail

MEDICARE: NORTHBROOK NH LLC

MEDICARE: NORTHBROOK NH 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 : 1548703085
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHBROOK NH LLC
Provider Business Mailing Address
First Line : 4101 LAKE COOK RD
Second Line :
City : NORTHBROOK
State : IL
Zip : 60062-1112
Country : US
Telephone Number : 847-562-1770
Fax Number : 847-562-1909
Provider Business Practice Location Address
First Line : 4101 LAKE COOK RD
Second Line :
City : NORTHBROOK
State : IL
Zip : 60062-1112
Country : US
Telephone Number : 847-562-1770
Fax Number : 847-562-1909
Authorized Official
Title or Position : PRESIDENT
Name : JAMES MASON
Credential :
Telephone Number : 813-347-7425
Provider Enumeration Date : 12/01/2016
Last Update Date : 06/25/2021

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Directions to “NORTHBROOK NH LLC ” Practice Location

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