WAUKEGAN TERRACE NPI 1568413821

NPI Information

  • NPI: 1568413821
  • Provider Name: WAUKEGAN TERRACE
  • Classification: Intermediate Care Facility, Mental Illness - 310500000X
  • Entity Type: Organization
  • Other Name: LAKE PARK CENTER
  • CLIA Number: 14D0414504
  • Address: 919 WASHINGTON PARK
    WAUKEGAN, IL
    ZIP 60085
  • Phone: (847) 623-9100

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NPI Details

WAUKEGAN TERRACE is an intermediate care facility mental illness in Waukegan, IL. The provider is a nursing facility that provides an intermediate level of nursing care to individuals whose functional abilities are significantly compromise by mental illness. WAUKEGAN TERRACE NPI is 1568413821. The provider is registered as an organization entity type.
The provider Other Name Is Lake Park Center.

The provider's business location address is:

919 WASHINGTON PARK
WAUKEGAN, IL
ZIP 60085-258
Phone: (847) 623-9100
Fax: (847) 623-9179

The provider's authorized official is Avrum Weinfeld .
The authorized official title is Cfo and has the following contact phone number (847) 674-5795.

The CLIA number assigned to this NPI record is 14D0414504 - skilled nursing facility/nursing facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/12/2006 and was last updated on 10/16/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1310500000XIntermediate Care Facility, Mental IllnessYes
2313M00000XNursing Facility/Intermediate Care Facility0027052ILLINOISNo

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1363109618MEDICAIDILLINOIS
20054304MEDICAIDILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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