Provider Demographics
NPI:1801432711
Name:SHERIDAN VILLAGE NURSING AND REHABILITATION CENTER LLC
Entity type:Organization
Organization Name:SHERIDAN VILLAGE NURSING AND REHABILITATION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YECHIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MASHIACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-791-0035
Mailing Address - Street 1:8707 SKOKIE BLVD STE 109
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-2200
Mailing Address - Country:US
Mailing Address - Phone:312-791-0035
Mailing Address - Fax:
Practice Address - Street 1:5838 N SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-4916
Practice Address - Country:US
Practice Address - Phone:773-769-2230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility