NPIMap

Organization Active NPI

Libertyville Manor Extended Care Facility, Inc.

  • Skilled Nursing Facility
  • Libertyville, IL
National Provider Identifier
1952390585
Registry record updated May 7, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
0017780 Issued in IL
Legal business name
LIBERTYVILLE MANOR EXTENDED CARE FACILITY, INC.
Practice address
610 Peterson Rd
(Highway #137)
Libertyville, IL 60048-1014
Phone
(847) 367-6100
Fax
(847) 680-2030
NPI assigned
Oct 17, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 7, 2009

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

Authorized official

Name
Ms. Gina Gamble
Title
Office Manager
Phone
(847) 367-6100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 0017780 IL Primary

Addresses

Primary practice location

610 Peterson Rd
(Highway #137)
Libertyville, IL 60048-1014

Mailing address

610 Peterson Rd
(Highway #137)
Libertyville, IL 60048-1014
Phone (847) 367-6100

National Provider Directory

National Provider Directory

Locations

325 N Milwaukee Ave
Libertyville, IL 60048

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1129507200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1241654400000",
    "number": "1952390585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 PETERSON RD",
            "address_2": "(HIGHWAY #137)",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600481014",
            "telephone_number": "847-367-6100",
            "fax_number": "847-680-2030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 PETERSON RD",
            "address_2": "(HIGHWAY #137)",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600481014",
            "telephone_number": "847-367-6100",
            "fax_number": "847-680-2030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTYVILLE MANOR EXTENDED CARE FACILITY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-17",
        "last_updated": "2009-05-07",
        "status": "A",
        "authorized_official_last_name": "GAMBLE",
        "authorized_official_first_name": "GINA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "847-367-6100",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "0017780",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Libertyville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2009; 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.