Organization
LIBERTYVILLE MANOR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MILAN STOKAVICH (ADMINISTRATOR)
(847) 367-6100
Entity
Organization
Contact information
Practice address
610 PETERSON RD, LIBERTYVILLE, IL 60048-1014
(847) 367-6100
Mailing address
1007 JENKISSON AVE, LAKE BLUFF, IL 60044-1623
(847) 234-9467
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
160000723
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
225200000
TAXONOMY
IL
Enumeration date
05/05/2009
Last updated
05/05/2009
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