Provider Demographics
NPI:1104828912
Name:SL LINCOLNWOOD LLC
Entity Type:Organization
Organization Name:SL LINCOLNWOOD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:312-673-4333
Mailing Address - Street 1:7000 N MCCORMICK BLVD
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-2726
Mailing Address - Country:US
Mailing Address - Phone:847-673-7166
Mailing Address - Fax:847-673-5872
Practice Address - Street 1:7000 N MCCORMICK BLVD
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-2726
Practice Address - Country:US
Practice Address - Phone:847-673-7166
Practice Address - Fax:847-673-5872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-11
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0045963314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL145786Medicare ID - Type UnspecifiedMEDICARE