MEDICARE: SOUTH LOOP 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
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1902215528
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH LOOP LIVING & REHAB CENTER 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	:	1725 S WABASH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-1219
Country	:	US
Telephone Number	:	312-922-2777
Fax Number	:

Authorized Official
Title or Position	:	ACCOUNTS RECEIVABLE MANAGER
Name	:	REUVEN LEVITIN
Credential	:
Telephone Number	:	847-676-5342

Provider Enumeration Date	:	08/07/2014
Last Update Date	:	08/07/2014

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