Provider Demographics
NPI:1912916966
Name:LONG GROVE MANOR INC
Entity Type:Organization
Organization Name:LONG GROVE MANOR INC
Other - Org Name:THE ARLINGTON REHABILITATION AND LIVING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEFKOVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-377-2400
Mailing Address - Street 1:1666 CHECKER RD
Mailing Address - Street 2:
Mailing Address - City:LONG GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60047-5289
Mailing Address - Country:US
Mailing Address - Phone:847-419-1111
Mailing Address - Fax:847-419-1119
Practice Address - Street 1:1666 CHECKER RD
Practice Address - Street 2:
Practice Address - City:LONG GROVE
Practice Address - State:IL
Practice Address - Zip Code:60047-5289
Practice Address - Country:US
Practice Address - Phone:847-419-1111
Practice Address - Fax:847-419-1119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0040899314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========002Medicaid
IL=========002Medicaid