Provider Demographics
NPI:1417083270
Name:LINCOLN PARK TERRACE, INC.
Entity type:Organization
Organization Name:LINCOLN PARK TERRACE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DOV
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLOMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-248-6000
Mailing Address - Street 1:2732 N HAMPDEN CT
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1612
Mailing Address - Country:US
Mailing Address - Phone:177-324-8600
Mailing Address - Fax:177-327-8970
Practice Address - Street 1:2732 N HAMPDEN CT
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1612
Practice Address - Country:US
Practice Address - Phone:177-324-8600
Practice Address - Fax:177-327-8970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0026203314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL145875Medicare ID - Type Unspecified