NPI 1912029521

Bayside Terrace LLC

Organisation Mental Illness Intermediate Care Facility Waukegan, IL

Practice location

Address: 1100 S Lewis Ave, Waukegan, IL 60085-7710
Phone: (847) 244-8196
Fax: (847) 244-7647

Authorised official

Name: Demetria C. Rafael
Title: Administrator
Phone: (847) 244-8196

Registered specialties

Mental Illness Intermediate Care Facility Primary

Nursing & Custodial Care Facilities Taxonomy 310500000X Licence 0023036 (IL)

Other Intermediate Care Facility, Mental Illness providers in Illinois →

Registry record

NPI: 1912029521
Entity type: Organization
NPI issued: 4 Apr 2007
Record last updated: 20 Jul 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.