Provider Demographics
NPI:1013063312
Name:LEXINGTON PRIVATE CARE SERVICES, INC
Entity Type:Organization
Organization Name:LEXINGTON PRIVATE CARE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FIANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTHELT
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:630-652-7915
Mailing Address - Street 1:665 W NORTH AVE STE 400-B
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-1189
Mailing Address - Country:US
Mailing Address - Phone:630-748-3700
Mailing Address - Fax:630-748-3701
Practice Address - Street 1:665 W NORTH AVE STE 400-B
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148
Practice Address - Country:US
Practice Address - Phone:630-748-3700
Practice Address - Fax:630-748-3701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-27
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL4000123251E00000X
IL3000168251E00000X
IL203.000700332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL203.000700OtherILLINOIS MEDICAL LICENSE
IL=========02Medicaid
1134190001Medicare ID - Type Unspecified