Provider Demographics
NPI:1598023533
Name:PARKER NURSING AND REHABILITATION LLC
Entity Type:Organization
Organization Name:PARKER NURSING AND REHABILITATION LLC
Other - Org Name:CROWN CREST OF PARKER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEFKOVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-412-9871
Mailing Address - Street 1:1425 MCHENRY RD
Mailing Address - Street 2:STE 209
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1332
Mailing Address - Country:US
Mailing Address - Phone:224-377-2400
Mailing Address - Fax:224-377-2491
Practice Address - Street 1:9398 CROWN CREST BOULEVARD
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-8697
Practice Address - Country:US
Practice Address - Phone:224-377-2400
Practice Address - Fax:224-377-2491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-27
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO25076833Medicaid
CO25076833Medicaid