Provider Demographics
NPI:1710149125
Name:LAKE BARRINGTON WOODS
Entity Type:Organization
Organization Name:LAKE BARRINGTON WOODS
Other - Org Name:SENIOR LIFESTYLE
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:
Authorized Official - Last Name:PLATSON-COX
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:847-842-8900
Mailing Address - Street 1:22320 CLASSIC CT
Mailing Address - Street 2:
Mailing Address - City:LAKE BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-5903
Mailing Address - Country:US
Mailing Address - Phone:847-842-8900
Mailing Address - Fax:847-381-7253
Practice Address - Street 1:22320 CLASSIC CT
Practice Address - Street 2:
Practice Address - City:LAKE BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-5903
Practice Address - Country:US
Practice Address - Phone:847-842-8900
Practice Address - Fax:847-381-7253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL5101875310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility