Provider Demographics
NPI:1528630837
Name:LIEBERMAN SKILLED NURSING FACILITY LLC
Entity type:Organization
Organization Name:LIEBERMAN SKILLED NURSING FACILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MBR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-745-7000
Mailing Address - Street 1:3450 OAKTON ST
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-2951
Mailing Address - Country:US
Mailing Address - Phone:847-745-7000
Mailing Address - Fax:
Practice Address - Street 1:9700 GROSS POINT RD
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1175
Practice Address - Country:US
Practice Address - Phone:847-674-7210
Practice Address - Fax:847-674-6366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility