Provider Demographics
NPI:1225585987
Name:SOUTH LOOP SKILLED NURSING FACILITY LLC
Entity Type:Organization
Organization Name:SOUTH LOOP SKILLED NURSING FACILITY LLC
Other - Org Name:WARREN BARR SOUTH LOOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YAIR
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUKERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-679-9797
Mailing Address - Street 1:3450 OAKTON ST
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-2951
Mailing Address - Country:US
Mailing Address - Phone:847-679-9797
Mailing Address - Fax:847-676-5348
Practice Address - Street 1:1725 S WABASH AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-1219
Practice Address - Country:US
Practice Address - Phone:312-922-2777
Practice Address - Fax:312-939-1820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid