Basic Information
| Provider Information | |||||||||
| NPI: | 1588788632 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LEXINGTON HEALTH CARE CENTER OF STREAMWOOD, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 665 W NORTH AVE | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | LOMBARD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601481134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6304584700 | ||||||||
| FaxNumber: | 6304584770 | ||||||||
| Practice Location | |||||||||
| Address1: | 815 E IRVING PARK RD | ||||||||
| Address2: | |||||||||
| City: | STREAMWOOD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601073073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6308375300 | ||||||||
| FaxNumber: | 6302139076 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2007 | ||||||||
| LastUpdateDate: | 11/11/2008 | ||||||||
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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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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BP3500X | 0037002 | IL | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Parenteral & Enteral Nutrition |
No ID Information.