Provider Demographics
NPI:1023429115
Name:MORNING VIEW ASSISTED LIVING LLC
Entity type:Organization
Organization Name:MORNING VIEW ASSISTED LIVING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHALOM
Authorized Official - Middle Name:
Authorized Official - Last Name:MENORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-679-6200
Mailing Address - Street 1:8833 GROSS POINT RD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1859
Mailing Address - Country:US
Mailing Address - Phone:847-679-6200
Mailing Address - Fax:847-679-6236
Practice Address - Street 1:475 N. NILES AVENUE
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617
Practice Address - Country:US
Practice Address - Phone:574-246-4123
Practice Address - Fax:574-283-1340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-12
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN13-013149-2310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN155752Medicaid