Organization
BAYSIDE TERRACE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEMETRIA C. RAFAEL RN (ADMINISTRATOR)
(847) 244-8196
Entity
Organization
Contact information
Practice address
1100 S LEWIS AVE, WAUKEGAN, IL 60085-7710
(847) 244-8196
(847) 244-7647
Mailing address
1100 S LEWIS AVE, WAUKEGAN, IL 60085-7710
(847) 244-8196
Taxonomy
Speciality
Code
Description
License number
State
310500000X
Mental Illness Intermediate Care Facility
Primary
0023036
IL
Other
Enumeration date
04/04/2007
Last updated
07/20/2016
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