Basic Information
| Provider Information | |||||||||
| NPI: | 1003800830 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LEXINGTON HEALTH CARE CENTER OF BLOOMINGDALE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 665 W NORTH AVE | ||||||||
| Address2: | STE 500 | ||||||||
| City: | LOMBARD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601481134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6304584700 | ||||||||
| FaxNumber: | 6304584770 | ||||||||
| Practice Location | |||||||||
| Address1: | 165 S BLOOMINGDALE RD | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGDALE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601081434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6309808700 | ||||||||
| FaxNumber: | 6309806170 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2005 | ||||||||
| LastUpdateDate: | 09/22/2021 | ||||||||
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| AuthorizedOfficialLastName: | SAMATAS | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6304584700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 09/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 313M00000X | 0035188 | IL | N | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility | 314000000X | 0035188 | IL | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.