Waukegan Terrace

Primary specialty

Mental Illness Intermediate Care FacilityTaxonomy code 310500000X

Legal business name

WAUKEGAN TERRACE

Doing business as

Lake Park Center,LLC

Practice address

919 Washington Park
Waukegan, IL 60085-7258

Phone

(847) 623-9100

Fax

(847) 623-9179

NPI assigned

May 12, 2006

Last updated

Oct 16, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Avrum Weinfeld

Title

Cfo

Phone

(847) 674-5795

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 2

• Lake Park Center,LLC Doing business as
• Lake Park Center Other name

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729036800000",
    "number": "1568413821",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5151 CHURCH ST",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600771123",
            "telephone_number": "847-933-9200",
            "fax_number": "847-674-5794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "919 WASHINGTON PARK",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600857258",
            "telephone_number": "847-623-9100",
            "fax_number": "847-623-9179"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAUKEGAN TERRACE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-12",
        "last_updated": "2024-10-16",
        "certification_date": "2024-10-16",
        "status": "A",
        "authorized_official_last_name": "WEINFELD",
        "authorized_official_first_name": "AVRUM",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "847-674-5795",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310500000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Mental Illness",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "IL",
            "license": "0027052",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "363109618",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0054304",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Park Center,LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lake Park Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Waukegan Illinois Hospital Company LLC (Vista Medical Center East)
• Waukegan Illinois Hospital Company LLC (Vista Medical Center East)
• Waukegan Illinois Hospital Company LLC (Vista Medical Center West)
• Waukegan Medical & Rehabilitation
• Waukegan Medical and Rehabilitation
• Kathleen K Weber
• Dan P Weckler, CADC
• Felicia Wedley
• Elijah Wedwick
• Nanette Ann Wegrzyn

• Mental Illness Intermediate Care Facility in Waukegan, IL
• Providers in Waukegan, IL by specialty
• Mental Illness Intermediate Care Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.