Provider Demographics
NPI:1417688649
Name:HICKORY VILLAGE NURSING AND REHABILITATION CENTER LLC
Entity Type:Organization
Organization Name:HICKORY VILLAGE NURSING AND REHABILITATION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MASHIACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-896-6723
Mailing Address - Street 1:8707 SKOKIE BLVD
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-2269
Mailing Address - Country:US
Mailing Address - Phone:773-896-6723
Mailing Address - Fax:
Practice Address - Street 1:9246 S ROBERTS RD
Practice Address - Street 2:
Practice Address - City:HICKORY HILLS
Practice Address - State:IL
Practice Address - Zip Code:60457-2066
Practice Address - Country:US
Practice Address - Phone:708-598-4040
Practice Address - Fax:708-598-3796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-20
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility