Provider Demographics
NPI:1477931756
Name:VILLA AT LINCOLN PARK, LLC
Entity Type:Organization
Organization Name:VILLA AT LINCOLN PARK, LLC
Other - Org Name:VILLA HEALTHCARE
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ISRAEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-440-2660
Mailing Address - Street 1:3701 W LUNT AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-2615
Mailing Address - Country:US
Mailing Address - Phone:847-440-2660
Mailing Address - Fax:
Practice Address - Street 1:1700 C A BECKER DR
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-4714
Practice Address - Country:US
Practice Address - Phone:847-440-2660
Practice Address - Fax:847-701-3308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-07
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2269314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI525061Medicare Oscar/Certification