Provider Demographics
NPI:1013403195
Name:SEDGEBROOK OPCO SL-VII LLC
Entity Type:Organization
Organization Name:SEDGEBROOK OPCO SL-VII LLC
Other - Org Name:RADFORD GREEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:REIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-222-6262
Mailing Address - Street 1:960 AUDUBON WAY
Mailing Address - Street 2:
Mailing Address - City:LINCOLNSHIRE
Mailing Address - State:IL
Mailing Address - Zip Code:60069-3886
Mailing Address - Country:US
Mailing Address - Phone:847-901-3319
Mailing Address - Fax:847-876-2403
Practice Address - Street 1:960 AUDUBON WAY
Practice Address - Street 2:
Practice Address - City:LINCOLNSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60069-3886
Practice Address - Country:US
Practice Address - Phone:847-901-3319
Practice Address - Fax:847-876-2403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-02
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility