BAYSIDE TERRACE LLC NPI 1912029521

NPI Information

  • NPI: 1912029521
  • Provider Name: BAYSIDE TERRACE LLC
  • Classification: Intermediate Care Facility, Mental Illness - 310500000X
  • Entity Type: Organization
  • CLIA Number: 14D0675295
  • Address: 1100 S LEWIS AVE
    WAUKEGAN, IL
    ZIP 60085
  • Phone: (847) 244-8196

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NPI Details

BAYSIDE TERRACE LLC 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. BAYSIDE TERRACE LLC NPI is 1912029521. The provider is registered as an organization entity type.

The provider's business location address is:

1100 S LEWIS AVE
WAUKEGAN, IL
ZIP 60085-710
Phone: (847) 244-8196
Fax: (847) 244-7647

The provider's authorized official is Demetria C. Rafael .
The authorized official title is Administrator and has the following contact phone number (847) 244-8196.

The CLIA number assigned to this NPI record is 14D0675295 - skilled nursing facility/nursing facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/4/2007 and was last updated on 7/20/2016.

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 Illness0023036ILLINOISYes

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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