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Organization
GAF/LAKE COOK TERRACE
Active
Organization
GAF/LAKE COOK TERRACE
Active
Other names
LAKE COOK HEALTH CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
MELODY GOODMAN (MDS COORDINATOR)
(847) 564-0505
Entity
Organization
Contact information
Practice address
263 SKOKIE BLVD, NORTHBROOK, IL 60062-1611
(847) 564-0505
Mailing address
263 SKOKIE BLVD, NORTHBROOK, IL 60062-1611
Taxonomy
Speciality
Code
Description
License number
State
311Z00000X
Custodial Care Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3639624779001
—
IL
Enumeration date
09/29/2005
Last updated
08/22/2020
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