Gaf/Lake Cook Terrace

Primary specialty

Custodial Care FacilityTaxonomy code 311Z00000X

Legal business name

GAF/LAKE COOK TERRACE

Practice address

263 Skokie Blvd
Northbrook, IL 60062-1611

Phone

(847) 564-0505

NPI assigned

Sep 29, 2005

Organization subpart

No

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

Authorized official

Name

Melody Goodman

Title

MDS Coordinator

Phone

(847) 564-0505

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• LAKE COOK HEALTH CENTER Doing business as

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

{
    "created_epoch": "1127952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1659368264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "263 SKOKIE BLVD",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600621611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "263 SKOKIE BLVD",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600621611",
            "telephone_number": "847-564-0505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GAF/LAKE COOK TERRACE",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GOODMAN",
        "authorized_official_first_name": "MELODY",
        "authorized_official_title_or_position": "MDS COORDINATOR",
        "authorized_official_telephone_number": "847-564-0505"
    },
    "taxonomies": [
        {
            "code": "311Z00000X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3639624779001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LAKE COOK HEALTH CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lauren Fulton, LCSW
• Functional Medical Wellness Center , LLC
• Anna Katerina Funk
• Joan Eileen Funk, PSY.D.
• Elizabeth Fyfe, M.S. CCC-SLP
• Joel Galiotto
• Tammy Louise Galizia, DPM
• Marie Ann Calayag Gallano
• Kayla Galvan
• Vanessa Galvan

• Custodial Care Facility in Northbrook, IL
• Providers in Northbrook, IL by specialty
• Custodial Care Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.