Provider Demographics
NPI:1508300658
Name:SPRING MEADOW NURSING & REHABILITATION CENTRE LLC
Entity Type:Organization
Organization Name:SPRING MEADOW NURSING & REHABILITATION CENTRE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-674-7600
Mailing Address - Street 1:1125 CLARION AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43528-8107
Mailing Address - Country:US
Mailing Address - Phone:419-866-6124
Mailing Address - Fax:
Practice Address - Street 1:7366 N LINCOLN AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-1708
Practice Address - Country:US
Practice Address - Phone:847-674-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH366042Medicare Oscar/Certification