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KANKAKEE TERRACE OPERATOR LLC

Nursing & Custodial Care Facilities Nursing Facility/Intermediate Care Facility

Provider NPI: 1326128554

Organization Information:
Organization Name:  KANKAKEE TERRACE OPERATOR LLC
Authorized Official:  AVRUM  WEINFELD  CFO  847-674-5795

Practice Location:
100 BELLE AIRE AVE  BOURBONNAIS, IL 60914-2006 US
Tel: 815-939-0910  Fax: 815-939-0973

Business Mailing Address:
6865 N LINCOLN AVE  LINCOLNWOOD, IL 60712-4611 US
Tel: 847-674-5795  Fax: 847-674-5794

NPI Information:
NPI: 1326128554
Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y313M00000XNursing & Custodial Care Facilities
Nursing Facility/Intermediate Care Facility
IL0022897

Other Provider Identifiers:

IssuerNumberStateType
362883311001IL05



American Medical Association 2012 taxonomy code information

Code: 313M00000X

Type:

Classification:



Definition:



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