Provider Demographics
NPI:1295805521
Name:LAKEVIEW NURSING AND REHABILITATION CENTRE INC
Entity type:Organization
Organization Name:LAKEVIEW NURSING AND REHABILITATION CENTRE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT 50 PERCENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BOREK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-256-7600
Mailing Address - Street 1:735 WEST DIVERSEY PARKWAY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-2337
Mailing Address - Country:US
Mailing Address - Phone:773-348-4055
Mailing Address - Fax:773-348-6259
Practice Address - Street 1:735 WEST DIVERSEY PARKWAY
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-2337
Practice Address - Country:US
Practice Address - Phone:773-348-4055
Practice Address - Fax:773-348-6259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1764042314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL959OtherBLUE CROSS BLUE SHIELD
IL=========6061401Medicaid
IL959OtherBLUE CROSS BLUE SHIELD
IL=========6061401Medicaid
IL145654Medicare PIN
IL145654Medicare Oscar/Certification