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NPI Code Detail

MEDICARE: CC CARE LLC

MEDICARE: CC CARE 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
1314000000XSkilled Nursing Facility

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1629340690
Entity Type Code : Organization
Provider Name (Legal Business Name) : CC CARE LLC
Provider Business Mailing Address
First Line : 4314 S WABASH AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60653-3119
Country : US
Telephone Number : 773-538-8300
Fax Number : 773-538-5775
Provider Business Practice Location Address
First Line : 4314 S WABASH AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60653-3119
Country : US
Telephone Number : 773-538-8300
Fax Number : 773-538-5775
Authorized Official
Title or Position : DIRECTOR
Name : MR. JAMIE NICKLE
Credential :
Telephone Number : 630-501-0996
Provider Enumeration Date : 02/06/2012
Last Update Date : 08/24/2016

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