Basic Information
Provider Information
NPI: 1902215528
EntityType: 2
ReplacementNPI:  
OrganizationName: SOUTH LOOP LIVING & REHAB CENTER LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: WARREN BARR SOUTH LOOP
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7040 N RIDGEWAY AVE
Address2:  
City: LINCOLNWOOD
State: IL
PostalCode: 607122620
CountryCode: US
TelephoneNumber: 8476799797
FaxNumber: 8476765348
Practice Location
Address1: 1725 S WABASH AVE
Address2:  
City: CHICAGO
State: IL
PostalCode: 606161219
CountryCode: US
TelephoneNumber: 3129222777
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/07/2014
LastUpdateDate: 08/07/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: LEVITIN
AuthorizedOfficialFirstName: REUVEN
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: ACCOUNTS RECEIVABLE MANAGER
AuthorizedOfficialTelephone: 8476765342
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
314000000X  Y Nursing & Custodial Care FacilitiesSkilled Nursing Facility 

No ID Information.


Home