MEDICARE: LAKEFRONT NURSING AND REHABILITATION 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	314000000X	Skilled Nursing Facility	1738852	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770533960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKEFRONT NURSING AND REHABILITATION LLC

Provider Business Mailing Address
First Line	:	7618 N SHERIDAN RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626-1418
Country	:	US
Telephone Number	:	847-743-7711
Fax Number	:	847-761-3387

Provider Business Practice Location Address
First Line	:	7618 N SHERIDAN RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626-1418
Country	:	US
Telephone Number	:	847-743-7711
Fax Number	:	847-761-3387

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MENACHEM SHABAT
Credential	:
Telephone Number	:	773-743-7711

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	08/22/2020

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