Provider Demographics
NPI:1326171919
Name:LEXINGTON HEALTH CARE CENTER OF LAKE ZURICH, INC.
Entity Type:Organization
Organization Name:LEXINGTON HEALTH CARE CENTER OF LAKE ZURICH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMATAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-458-4700
Mailing Address - Street 1:665 W NORTH AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-1134
Mailing Address - Country:US
Mailing Address - Phone:630-458-4700
Mailing Address - Fax:630-458-4770
Practice Address - Street 1:900 S RAND RD
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-2450
Practice Address - Country:US
Practice Address - Phone:847-726-1200
Practice Address - Fax:847-726-1265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0039768332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2596460001Medicare NSC