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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