Provider Demographics
NPI:1891943858
Name:GROVE OF SKOKIE LIVING AND REHAB CENTER, LLC
Entity Type:Organization
Organization Name:GROVE OF SKOKIE LIVING AND REHAB CENTER, LLC
Other - Org Name:THE GROVE OF SKOKIE LIVING & REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMPTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:REUVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVITAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-676-5342
Mailing Address - Street 1:9000 LAVERGNE AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1618
Mailing Address - Country:US
Mailing Address - Phone:847-679-2322
Mailing Address - Fax:847-679-9325
Practice Address - Street 1:9000 LAVERGNE AVE
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1618
Practice Address - Country:US
Practice Address - Phone:847-679-2322
Practice Address - Fax:847-679-9325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14-5860Medicare PIN