1700957925 NPI number — CALIFORNIA GARDENS CORP.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700957925 NPI number — CALIFORNIA GARDENS CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CALIFORNIA GARDENS CORP.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CALIFORNIA GARDENS NURSING AND REHABILITATION CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700957925
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7257 N LINCOLN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINCOLNWOOD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60712-1810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-933-2600
Provider Business Mailing Address Fax Number:
847-933-0686

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2829 S CALIFORNIA BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60608-5106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-847-8061
Provider Business Practice Location Address Fax Number:
773-847-1603
Provider Enumeration Date:
11/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LEVITIN
Authorized Official First Name:
REUVEN
Authorized Official Middle Name:
Authorized Official Title or Position:
PATIENT ACCOUNTS MANAGER
Authorized Official Telephone Number:
847-745-6240

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BN1400X , with the licence number: 5004070001 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: 5004070001 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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