Organization
LAKE FOREST PLACE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK HAVRILKA (CHIEF FINANCIAL OFFICER)
(847) 979-3904
Entity
Organization
Contact information
Practice address
1100 PEMBRIDGE DR, LAKE FOREST, IL 60045-4228
(847) 604-6700
(847) 979-3969
Mailing address
1100 PEMBRIDGE DR, LAKE FOREST, IL 60045-4228
(847) 437-6700
(847) 316-8723
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
12/22/2015
Last updated
10/08/2021
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