Provider Demographics
NPI:1811987951
Name:LEBANON NURSING & REHABILITATION CENTER LLC
Entity type:Organization
Organization Name:LEBANON NURSING & REHABILITATION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:FEIGENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-677-9823
Mailing Address - Street 1:6600 N SAINT LOUIS AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-3726
Mailing Address - Country:US
Mailing Address - Phone:847-677-9823
Mailing Address - Fax:847-677-9837
Practice Address - Street 1:115 OREGONIA RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-1983
Practice Address - Country:US
Practice Address - Phone:513-932-1121
Practice Address - Fax:513-934-0899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1619-NH314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2408862Medicaid
OH365690Medicare ID - Type Unspecified