1962837542 NPI number — ORCHARD GROVE NURSING & REHAB CENTER LLC

Table of content: (NPI 1962837542)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962837542 NPI number — ORCHARD GROVE NURSING & REHAB CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORCHARD GROVE NURSING & 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:
Provider Other Organization Name Type Code:
6
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:
1962837542
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/22/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7383 N LINCOLN AVE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
LINCOLNWOOD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60712-1734
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-440-2233
Provider Business Mailing Address Fax Number:
847-430-5283

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1385 E EMPIRE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BENTON HARBOR
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49022-2037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-925-0033
Provider Business Practice Location Address Fax Number:
269-925-2019
Provider Enumeration Date:
09/13/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ARYEH
Authorized Official First Name:
MOSHE
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
773-793-0167

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  L2523908 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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