Basic Information
| Provider Information | |||||||||
| NPI: | 1538500996 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EVERGREEN LIVING & REHAB CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7040 N RIDGEWAY AVE | ||||||||
| Address2: | |||||||||
| City: | LINCOLNWOOD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 607122620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476799797 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10124 S KEDZIE AVE | ||||||||
| Address2: | |||||||||
| City: | EVERGREEN PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 608053738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7089077000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2013 | ||||||||
| LastUpdateDate: | 12/05/2013 | ||||||||
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| AuthorizedOfficialLastName: | LEVITIN | ||||||||
| AuthorizedOfficialFirstName: | REUVEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | ACCOUNTS RECEIVABLE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8476765342 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.