Provider Demographics
NPI:1437471075
Name:KENSINGTON PLACE NURSING AND REHABILITATION CENTER LLC
Entity Type:Organization
Organization Name:KENSINGTON PLACE NURSING AND REHABILITATION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YECHIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MASHIACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-905-4000
Mailing Address - Street 1:3405 S MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-3819
Mailing Address - Country:US
Mailing Address - Phone:312-791-0035
Mailing Address - Fax:312-791-0626
Practice Address - Street 1:3405 S MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-3819
Practice Address - Country:US
Practice Address - Phone:312-791-0035
Practice Address - Fax:312-791-0626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-24
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL313M00000X
IL0050716314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL270990816001Medicaid
IL270990816001Medicaid