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NPI Code Detail

MEDICARE: NORTHBROOK SKILLED NURSING FACILITY LLC

MEDICARE: NORTHBROOK SKILLED NURSING FACILITY 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 : 1871965186
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHBROOK SKILLED NURSING FACILITY LLC
Provider Business Mailing Address
First Line : 7040 N RIDGEWAY AVE
Second Line :
City : LINCOLNWOOD
State : IL
Zip : 60712-2620
Country : US
Telephone Number : 847-679-9797
Fax Number : 847-676-5348
Provider Business Practice Location Address
First Line : 263 SKOKIE BLVD
Second Line :
City : NORTHBROOK
State : IL
Zip : 60062-1611
Country : US
Telephone Number : 847-564-0505
Fax Number : 847-564-3775
Authorized Official
Title or Position : CEO
Name : YAIR ZUCKERMAN
Credential :
Telephone Number : 847-679-9797
Provider Enumeration Date : 10/26/2015
Last Update Date : 12/15/2015

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