SKOKIE MEADOWS BEHAVIORAL HEALTH CTR (SKOKIE MEADOWS NURSING CENTERS II, LLC) NPI 1003004565

Intermediate Care Facility, Mental Illness in Skokie, IL

Organization Intermediate Care Facility, Mental Illne... CLIA Number 14D0882844 CLIA Certificate of Waiver

About SKOKIE MEADOWS BEHAVIORAL HEALTH CTR (SKOKIE MEADOWS NURSING CENTERS II, LLC)

Skokie Meadows Behavioral Health Ctr (skokie Meadows Nursing Centers Ii,llc) is a provider established in Skokie, Illinois specializing in intermediate care facility, mental illness. The NPI number of Skokie Meadows Behavioral Health Ctr (skokie Meadows Nursing Centers Ii,llc) is 1003004565 and was assigned on October 2007. The practitioner's primary taxonomy code is 310500000X with license number 0031393 (IL). The provider is registered as an organization and their NPI record was last updated 5 years ago. The provider's is doing business as Skokie Meadows Behavioral Health Ctr. The authorized official of this NPI record is Mark Appel (Member)

The CLIA number of Skokie Meadows Behavioral Health Ctr is 14D0882844 registered as a "other" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to Skokie Meadows Behavioral Health Ctr to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

NPI

1003004565

Provider NameSKOKIE MEADOWS BEHAVIORAL HEALTH CTR (SKOKIE MEADOWS NURSING CENTERS II,LLC)
Provider Location Address4600 GOLF RD SKOKIE, IL 60076
Provider Mailing Address4600 GOLF RD SKOKIE, IL 60076
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Other Organization NameSKOKIE MEADOWS BEHAVIORAL HEALTH CTR
Other Name TypeDoing Business As (3)
Enumeration Date10-10-2007
Last Update Date05-24-2016

Primary Taxonomy

Taxonomy Code310500000X
ClassificationIntermediate Care Facility, Mental Illness
TypeNursing & Custodial Care Facilities
License No.0031393
License StateIL
Taxonomy DescriptionA nursing facility that provides an intermediate level of nursing care to individuals whose functional abilities are significantly compromise by mental illness.

Business Address

SKOKIE MEADOWS BEHAVIORAL HEALTH CTR
4600 GOLF RD
SKOKIE, IL
ZIP 60076
Phone: (847) 679-4161
Fax: (847) 679-3241

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Mailing Address

SKOKIE MEADOWS BEHAVIORAL HEALTH CTR
4600 GOLF RD
SKOKIE, IL
ZIP 60076
Phone: (847) 679-4161
Fax: (847) 679-3241

Authorized Official

Authorized Official Name MARK APPEL
Authorized Official TitleMEMBER
Authorized Official Phone(847) 679-4161

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for the NPI number 1003004565 is:

CLIA Number14D0882844
Facility TypeOTHER
Certificate TypeCertificate of Waiver

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
=========001MEDICAID (05)IL

Other Providers at the same location


The following provider is registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1366081341SKOKIE MEADOWS LLC
Organization
Intermediate Care Facility, Mental Illness4600 GOLF RD
SKOKIE, IL 60076
(847) 679-1157

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.