Provider Demographics
NPI:1306201009
Name:TRANSITIONAL CARE OF LAKE COUNTY, LLC
Entity Type:Organization
Organization Name:TRANSITIONAL CARE OF LAKE COUNTY, LLC
Other - Org Name:WINCHESTER HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:HABER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-982-1717
Mailing Address - Street 1:5 REVERE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-8000
Mailing Address - Country:US
Mailing Address - Phone:847-377-7200
Mailing Address - Fax:480-436-5749
Practice Address - Street 1:850 E US HIGHWAY 45
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-4612
Practice Address - Country:US
Practice Address - Phone:847-377-7200
Practice Address - Fax:480-436-5749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-22
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0054049314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility