Provider Demographics
NPI:1982946604
Name:ADMIRAL AT THE LAKE
Entity Type:Organization
Organization Name:ADMIRAL AT THE LAKE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHAIM
Authorized Official - Middle Name:
Authorized Official - Last Name:DUBOVICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-433-1800
Mailing Address - Street 1:929 W FOSTER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-1491
Mailing Address - Country:US
Mailing Address - Phone:773-433-1800
Mailing Address - Fax:
Practice Address - Street 1:933 W. FOSTER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640
Practice Address - Country:US
Practice Address - Phone:773-433-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-20
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility