Healthcare Provider Details

I. General information

NPI: 1639747629
Provider Name (Legal Business Name): CHICAGO RIDGE SNF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10602 SOUTHWEST HWY
CHICAGO RIDGE IL
60415-1429
US

IV. Provider business mailing address

3531 HOWARD ST STE 1006
SKOKIE IL
60076-4056
US

V. Phone/Fax

Practice location:
  • Phone: 708-448-1540
  • Fax:
Mailing address:
  • Phone: 847-383-9102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. AARON SINGER
Title or Position: AUTHORIZED SIGNATORY
Credential:
Phone: 847-383-9102