Provider Demographics
NPI:1407576267
Name:NORTHWEST NURSING & REHABILITATION LLC
Entity Type:Organization
Organization Name:NORTHWEST NURSING & REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ARCHIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ARCHIE SHKOP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-450-1425
Mailing Address - Street 1:7358 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-1710
Mailing Address - Country:US
Mailing Address - Phone:602-882-1273
Mailing Address - Fax:
Practice Address - Street 1:17600 CALI DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2703
Practice Address - Country:US
Practice Address - Phone:281-440-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility