Provider Demographics
NPI:1184664369
Name:COUNCIL FOR JEWISH ELDERLY
Entity Type:Organization
Organization Name:COUNCIL FOR JEWISH ELDERLY
Other - Org Name:LIEBERMAN CENTER FOR HEALTH AND REHABILIATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT & CFO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:LOCKWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-508-1072
Mailing Address - Street 1:3003 W TOUHY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-2833
Mailing Address - Country:US
Mailing Address - Phone:847-674-7210
Mailing Address - Fax:847-674-6366
Practice Address - Street 1:9700 GROSS POINT RD
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1175
Practice Address - Country:US
Practice Address - Phone:847-674-7210
Practice Address - Fax:847-674-6366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0026195314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL145931Medicare Oscar/Certification