Provider Demographics
NPI:1255408704
Name:GLENLAKE TERRACE NURSING AND REHABILITATION CENTRE LTD
Entity type:Organization
Organization Name:GLENLAKE TERRACE NURSING AND REHABILITATION CENTRE LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ATTORNEY
Authorized Official - Prefix:MS
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:
Authorized Official - Last Name:MEEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-207-6468
Mailing Address - Street 1:2222 14TH ST
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-7708
Mailing Address - Country:US
Mailing Address - Phone:847-249-2400
Mailing Address - Fax:847-429-0536
Practice Address - Street 1:2222 14TH ST
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-7708
Practice Address - Country:US
Practice Address - Phone:847-249-2400
Practice Address - Fax:847-429-0536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
145669Medicare ID - Type Unspecified