Provider Demographics
NPI:1003004565
Name:SKOKIE MEADOWS NURSING CENTERS II,LLC
Entity Type:Organization
Organization Name:SKOKIE MEADOWS NURSING CENTERS II,LLC
Other - Org Name:SKOKIE MEADOWS BEHAVIORAL HEALTH CTR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:APPEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-679-4161
Mailing Address - Street 1:4600 GOLF RD
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1210
Mailing Address - Country:US
Mailing Address - Phone:847-679-4161
Mailing Address - Fax:847-679-3241
Practice Address - Street 1:4600 GOLF RD
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1210
Practice Address - Country:US
Practice Address - Phone:847-679-4161
Practice Address - Fax:847-679-3241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0031393310500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid