Basic Information
| Provider Information | |||||||||
| NPI: | 1023429115 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MORNING VIEW ASSISTED LIVING LLC | ||||||||
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| OtherOrganizationName: | MORNING VIEW NURSING AND REHABILITATION CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8833 GROSS POINT RD | ||||||||
| Address2: | SUITE 308 | ||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600771859 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476796200 | ||||||||
| FaxNumber: | 8476796236 | ||||||||
| Practice Location | |||||||||
| Address1: | 475 N. NILES AVENUE | ||||||||
| Address2: | |||||||||
| City: | SOUTH BEND | ||||||||
| State: | IN | ||||||||
| PostalCode: | 46617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5742464123 | ||||||||
| FaxNumber: | 5742831340 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2014 | ||||||||
| LastUpdateDate: | 12/21/2015 | ||||||||
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| AuthorizedOfficialLastName: | MENORA | ||||||||
| AuthorizedOfficialFirstName: | SHALOM | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8476796200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | 13-013149-2 | IN | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
ID Information
| ID | Type | State | Issuer | Description | 155752 | 05 | IN | MEDICAID |