Provider Demographics
NPI:1447749080
Name:PLYMOUTH COURT SNF, LLC
Entity Type:Organization
Organization Name:PLYMOUTH COURT SNF, LLC
Other - Org Name:SKLD PLYMOUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YAIR
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUCKERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-517-4777
Mailing Address - Street 1:620 DAVIS ST STE 200
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4419
Mailing Address - Country:US
Mailing Address - Phone:312-590-1055
Mailing Address - Fax:
Practice Address - Street 1:105 N HAGGERTY RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170
Practice Address - Country:US
Practice Address - Phone:734-455-0510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-09
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility