Basic Information
| Provider Information | |||||||||
| NPI: | 1467836411 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CRG LYNWOOD, LLC | ||||||||
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| OtherOrganizationName: | LYNWOOD MANOR HEALTHCARE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4711 GOLF RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600761224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8479339280 | ||||||||
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| Practice Location | |||||||||
| Address1: | 730 KIMOLE LN | ||||||||
| Address2: | |||||||||
| City: | ADRIAN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492211463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5172636771 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2015 | ||||||||
| LastUpdateDate: | 07/20/2015 | ||||||||
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| AuthorizedOfficialLastName: | GUTNICKI | ||||||||
| AuthorizedOfficialFirstName: | ABRAHAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8479339280 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BN1400X | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Nursing Facility Supplies |
No ID Information.