Provider Demographics
NPI:1962837542
Name:ORCHARD GROVE NURSING & REHAB CENTER LLC
Entity type:Organization
Organization Name:ORCHARD GROVE NURSING & REHAB CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MOSHE
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ARYEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-793-0167
Mailing Address - Street 1:7383 N LINCOLN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-1734
Mailing Address - Country:US
Mailing Address - Phone:847-440-2233
Mailing Address - Fax:847-430-5283
Practice Address - Street 1:1385 E EMPIRE AVE
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-2037
Practice Address - Country:US
Practice Address - Phone:269-925-0033
Practice Address - Fax:269-925-2019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-13
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL2523908314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI235544Medicare Oscar/Certification