MEDICARE: ST AGNES MANOR 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
1	314000000X	Skilled Nursing Facility	0027870	IL

General Provider Information

NPI Number	:	1699746420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST AGNES MANOR INC

Provider Business Mailing Address
First Line	:	1541 N WELLS ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60610-1307
Country	:	US
Telephone Number	:	312-787-9400
Fax Number	:	312-787-9434

Provider Business Practice Location Address
First Line	:	1725 S WABASH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-1219
Country	:	US
Telephone Number	:	312-922-2777
Fax Number	:	312-939-1820

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. PETER J O'BRIEN
Credential	:
Telephone Number	:	312-787-9400

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	08/22/2020

Similar Medicare Providers

1174509020 — SHELDON M HIRSCH MD
Practice Location Address:

1717 S WABASH AVE
CHICAGO, IL
60616-1219

Practice Phone: 312-913-0110
Practice Fax: 312-913-9154

1568497162 — MRS. SOPHIA NORMA TAYLOR APN
Practice Location Address:

1725 S WABASH AVE
CHICAGO, IL
60616-1219

Practice Phone: 312-922-2777
Practice Fax:

1700991551 — DIALYSIS CENTERS OF AMERICA - ILLINOIS, INC.
Practice Location Address:

1717 S WABASH AVE
CHICAGO, IL
60616-1219

Practice Phone: 312-913-0000
Practice Fax: 312-913-0077

1902972524 — MRS. ANGELA MARIE HUISMAN PA-C
Practice Location Address:

1725 S WABASH AVE
CHICAGO, IL
60616-1219

Practice Phone: 872-231-3162
Practice Fax:

1649433376 — LAKESIDE NEPHROLGOY LTD/PRARIE
Practice Location Address:

1717 S WABASH AVE
CHICAGO, IL
60616-1219

Practice Phone: 312-913-0110
Practice Fax: 312-913-9154

1902215528 — SOUTH LOOP LIVING & REHAB CENTER LLC
Practice Location Address:

1725 S WABASH AVE
CHICAGO, IL
60616-1219

Practice Phone: 312-922-2777
Practice Fax:

Directions to “ST AGNES MANOR INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.