Provider Demographics
NPI:1710974993
Name:OAKTON PAVILLION, INC.
Entity Type:Organization
Organization Name:OAKTON PAVILLION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:CNHA
Authorized Official - Phone:847-299-5588
Mailing Address - Street 1:1660 OAKTON PL
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-2045
Mailing Address - Country:US
Mailing Address - Phone:847-299-5588
Mailing Address - Fax:847-493-6525
Practice Address - Street 1:1660 OAKTON PL
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60018-2045
Practice Address - Country:US
Practice Address - Phone:847-299-5588
Practice Address - Fax:847-493-6525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0025056314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0025056Medicaid
IL0025056Medicaid