Provider Demographics
NPI:1962657890
Name:LINCOLNSHIRE SENIOR CARE LLC
Entity Type:Organization
Organization Name:LINCOLNSHIRE SENIOR CARE LLC
Other - Org Name:RADFORD GREEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO & PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:REIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-222-6262
Mailing Address - Street 1:960 AUDUBON WAY
Mailing Address - Street 2:
Mailing Address - City:LINCOLNSHIRE
Mailing Address - State:IL
Mailing Address - Zip Code:60069
Mailing Address - Country:US
Mailing Address - Phone:847-876-2401
Mailing Address - Fax:
Practice Address - Street 1:960 AUDUBON WAY
Practice Address - Street 2:ROSE COURT
Practice Address - City:LINCOLNSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60069
Practice Address - Country:US
Practice Address - Phone:847-876-2401
Practice Address - Fax:847-876-2402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-19
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0051219314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL146136Medicare Oscar/Certification