Provider Demographics
NPI:1467836411
Name:CRG LYNWOOD, LLC
Entity Type:Organization
Organization Name:CRG LYNWOOD, LLC
Other - Org Name:LYNWOOD MANOR HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTNICKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-933-9280
Mailing Address - Street 1:4711 GOLF RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1224
Mailing Address - Country:US
Mailing Address - Phone:847-933-9280
Mailing Address - Fax:
Practice Address - Street 1:730 KIMOLE LN
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1463
Practice Address - Country:US
Practice Address - Phone:517-263-6771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-18
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies