Healthcare Provider Details

I. General information

NPI: 1407105208
Provider Name (Legal Business Name): CENTER FOR SENIORS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2012
Last Update Date: 04/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5320 N. KEDZIE AVE
CHICAGO IL
60625-4712
US

IV. Provider business mailing address

5320 N. KEDZIE AVE
CHICAGO IL
60625-4712
US

V. Phone/Fax

Practice location:
  • Phone: 773-478-1245
  • Fax: 773-478-4070
Mailing address:
  • Phone: 773-478-1245
  • Fax: 773-478-4070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberADS 1013007
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberADS1313002
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberADS 1012011
License Number StateIL

VIII. Authorized Official

Name: JAE KWAN HA
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 773-478-1245