Provider Demographics
NPI:1750328522
Name:LIFESPACE COMMUNITIES INC
Entity Type:Organization
Organization Name:LIFESPACE COMMUNITIES INC
Other - Org Name:BEACON HILL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMPLIANCE, AUDIT & PRIVACY OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:NUTTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-309-7803
Mailing Address - Street 1:2400 S FINLEY RD
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-7029
Mailing Address - Country:US
Mailing Address - Phone:630-620-5850
Mailing Address - Fax:630-691-8715
Practice Address - Street 1:2400 S FINLEY RD
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-7029
Practice Address - Country:US
Practice Address - Phone:630-620-5850
Practice Address - Fax:630-691-8715
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFESPACE COMMUNITIES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-01
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL145522314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
145522Medicare Oscar/Certification