Provider Demographics
NPI:1992704811
Name:SKOKIE MEADOWS NURSING CENTER II
Entity type:Organization
Organization Name:SKOKIE MEADOWS NURSING CENTER II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:APPEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-679-7733
Mailing Address - Street 1:4600 GOLF RD
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1210
Mailing Address - Country:US
Mailing Address - Phone:847-679-7733
Mailing Address - Fax:
Practice Address - Street 1:9933 LAWLER AVE
Practice Address - Street 2:STE #350, C/O PREMIER MANAGEMENT CO
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-3703
Practice Address - Country:US
Practice Address - Phone:847-679-7733
Practice Address - Fax:847-679-7736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0031393313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========002Medicaid