1508014564 NPI number — THE GROVE AT LINCOLN PARK LIVING & REHAB CENTER, LLC

Table of content: DIANA LYNN STURGILL LPN (NPI 1780810747)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508014564 NPI number — THE GROVE AT LINCOLN PARK LIVING & REHAB CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE GROVE AT LINCOLN PARK LIVING & REHAB CENTER, LLC
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:
THE GROVE AT LINCOLN PARK LIVING & REHAB 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:
1508014564
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2732 N HAMPDEN CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60614-1612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-248-6000
Provider Business Mailing Address Fax Number:
773-248-9703

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2732 N HAMPDEN CT
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:
60614-1612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-248-6000
Provider Business Practice Location Address Fax Number:
773-248-9703
Provider Enumeration Date:
09/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LEVITIN
Authorized Official First Name:
REUVEN
Authorized Official Middle Name:
Authorized Official Title or Position:
COMTROLLER
Authorized Official Telephone Number:
847-676-5342

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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