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NPI Code Detail

MEDICARE: SYMPHONY PARK SOUTH LLC

MEDICARE: SYMPHONY PARK SOUTH 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

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
114-5764OTHERMEDICARE ID

General Provider Information

NPI Number : 1881072551
Entity Type Code : Organization
Provider Name (Legal Business Name) : SYMPHONY PARK SOUTH LLC
Provider Business Mailing Address
First Line : 7257 N LINCOLN AVE
Second Line :
City : LINCOLNWOOD
State : IL
Zip : 60712-1810
Country : US
Telephone Number : 847-745-6212
Fax Number :
Provider Business Practice Location Address
First Line : 10935 S HALSTED ST
Second Line :
City : CHICAGO
State : IL
Zip : 60628-3127
Country : US
Telephone Number : 773-928-2000
Fax Number :
Authorized Official
Title or Position : AUTHORIZED OFFICIAL
Name : DAVID HARTMAN
Credential :
Telephone Number : 847-745-6212
Provider Enumeration Date : 05/13/2015
Last Update Date : 09/15/2015

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Directions to “SYMPHONY PARK SOUTH LLC ” Practice Location

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