Basic Information
| Provider Information | |||||||||
| NPI: | 1770616385 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LEXINGTON HEALTH CARE CENTER OF ORLAND PARK | ||||||||
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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: | 14601 JOHN HUMPHREY DR | ||||||||
| Address2: | |||||||||
| City: | ORLAND PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604622641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7083498300 | ||||||||
| FaxNumber: | 7083494093 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2007 | ||||||||
| LastUpdateDate: | 10/17/2008 | ||||||||
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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 | 0041855 | IL | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Parenteral & Enteral Nutrition |
No ID Information.