| NPI | 1053803031 |
|---|---|
| Doing Business As | EDENBROOK LAKESIDE |
| Entity Type | Organization |
| Authorized Contact | MAX STESEL Owner 773-825-3336 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: WI 3150) |
| Enumeration Date | 2018-06-05 |
| Last Update Date | 2020-09-16 |