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NPI Code Detail

MEDICARE: MID-AMERICA CONVALESCENT CENTERS, INC.

MEDICARE: MID-AMERICA CONVALESCENT CENTERS, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility0047035IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11134OTHERILBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1083821102
Entity Type Code : Organization
Provider Name (Legal Business Name) : MID-AMERICA CONVALESCENT CENTERS, INC.
Provider Business Mailing Address
First Line : 3553 W PETERSON AVE
Second Line : SUITE 300
City : CHICAGO
State : IL
Zip : 60659-3200
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4920 N KENMORE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60640-3710
Country : US
Telephone Number : 773-769-2700
Fax Number :
Authorized Official
Title or Position : ADMINISTRATOR
Name : YEHOSHUA DAVIS
Credential :
Telephone Number : 773-463-1313
Provider Enumeration Date : 05/17/2007
Last Update Date : 04/20/2008

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Directions to “MID-AMERICA CONVALESCENT CENTERS, INC. ” Practice Location

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