MEDICARE: AGING WITH DIGNITY LLC

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
1	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	149.001031	OTHER	IL	LICENSED CLINICAL SOCIAL WORKER

General Provider Information

NPI Number	:	1245894021
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGING WITH DIGNITY LLC

Provider Business Mailing Address
First Line	:	525 W HAWTHORNE PL APT 3104
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-2961
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	525 W HAWTHORNE PL APT 3104
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-2961
Country	:	US
Telephone Number	:	847-624-9235
Fax Number	:

Authorized Official
Title or Position	:	PRINCIPAL
Name	:	DENISE BEAUFAIT
Credential	:	LCSW, ACSW
Telephone Number	:	847-624-9235

Provider Enumeration Date	:	04/26/2019
Last Update Date	:	04/26/2019

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Directions to “AGING WITH DIGNITY LLC ” Practice Location

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