Provider Demographics
NPI:1669055943
Name:LAKE ZURICH SKILLED NURSING FACILITY LLC
Entity type:Organization
Organization Name:LAKE ZURICH SKILLED NURSING FACILITY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MORDECHAY
Authorized Official - Middle Name:
Authorized Official - Last Name:NINIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-676-5315
Mailing Address - Street 1:3450 OAKTON ST
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-2951
Mailing Address - Country:US
Mailing Address - Phone:847-679-9797
Mailing Address - Fax:847-679-1126
Practice Address - Street 1:900 S RAND RD
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-2450
Practice Address - Country:US
Practice Address - Phone:847-726-1200
Practice Address - Fax:847-726-1265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-04
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility