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Organization
WAUKEGAN TERRACE
Active
Organization
WAUKEGAN TERRACE
Active
Other names
Lake Park Center,LLC, Lake Park Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. AVRUM WEINFELD (CFO)
(847) 674-5795
Entity
Organization
Contact information
Practice address
919 WASHINGTON PARK, WAUKEGAN, IL 60085-7258
(847) 623-9100
(847) 623-9179
Mailing address
5151 CHURCH ST, SKOKIE, IL 60077-1123
(847) 933-9200
(847) 674-5794
Taxonomy
Speciality
Code
Description
License number
State
310500000X
Mental Illness Intermediate Care Facility
Primary
—
—
313M00000X
Nursing Facility/Intermediate Care Facility
0027052
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0054304
—
IL
05
—
363109618
—
IL
Enumeration date
05/12/2006
Last updated
10/16/2024
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