Provider Demographics
NPI:1184719197
Name:THE TERRACE NH OPERATOR LLC
Entity type:Organization
Organization Name:THE TERRACE NH OPERATOR LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:AVRUM
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINFELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-674-5795
Mailing Address - Street 1:6865 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-4611
Mailing Address - Country:US
Mailing Address - Phone:847-674-5795
Mailing Address - Fax:847-674-5794
Practice Address - Street 1:1615 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60087-3810
Practice Address - Country:US
Practice Address - Phone:847-244-6700
Practice Address - Fax:847-244-7925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0043943314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL364228300001Medicaid
IL364228300001Medicaid