MEDICARE: CHICAGO COMMONS ASSOCIATION

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	261QA0600X	Adult Day Care Clinic/Center	261QA0600X	IL

General Provider Information

NPI Number	:	1487079182
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHICAGO COMMONS ASSOCIATION

Provider Business Mailing Address
First Line	:	4349 W WASHINGTON BLVD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60624-2211
Country	:	US
Telephone Number	:	773-473-7111
Fax Number	:	773-373-7862

Provider Business Practice Location Address
First Line	:	4349 W WASHINGTON BLVD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60624-2211
Country	:	US
Telephone Number	:	773-473-7111
Fax Number	:	773-373-7862

Authorized Official
Title or Position	:	VP OF SENIOR CARE
Name	:	CARY CRAWFORD
Credential	:
Telephone Number	:	773-826-3160

Provider Enumeration Date	:	03/04/2014
Last Update Date	:	03/04/2014

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Directions to “CHICAGO COMMONS ASSOCIATION ” Practice Location

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