Provider Demographics
NPI:1508014564
Name:THE GROVE AT LINCOLN PARK LIVING & REHAB CENTER, LLC
Entity Type:Organization
Organization Name:THE GROVE AT LINCOLN PARK LIVING & REHAB CENTER, LLC
Other - Org Name:THE GROVE AT LINCOLN PARK LIVING & REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:REUVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVITIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-676-5342
Mailing Address - Street 1:2732 N HAMPDEN CT
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1612
Mailing Address - Country:US
Mailing Address - Phone:773-248-6000
Mailing Address - Fax:773-248-9703
Practice Address - Street 1:2732 N HAMPDEN CT
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1612
Practice Address - Country:US
Practice Address - Phone:773-248-6000
Practice Address - Fax:773-248-9703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14-5875Medicare PIN