MEDICARE: SIERRA RIDGE SLF, 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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1750096459
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIERRA RIDGE SLF, LLC

Provider Business Mailing Address
First Line	:	4105 OAKTON STREET
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60076
Country	:	US
Telephone Number	:	847-423-0900
Fax Number	:

Provider Business Practice Location Address
First Line	:	4150 GATLING BLVD
Second Line	:
City	:	COUNTRY CLUB HILLS
State	:	IL
Zip	:	60478-2024
Country	:	US
Telephone Number	:	708-957-8300
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	ELCHANAN FINESTONE
Credential	:
Telephone Number	:	847-423-0900

Provider Enumeration Date	:	01/17/2023
Last Update Date	:	10/02/2023

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