Healthcare Provider Details

I. General information

NPI: 1598026676
Provider Name (Legal Business Name): CHICAGO COMMONS ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2012
Last Update Date: 03/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 E 50TH ST 200
CHICAGO IL
60615-2401
US

IV. Provider business mailing address

515 E 50TH ST 200
CHICAGO IL
60615-2401
US

V. Phone/Fax

Practice location:
  • Phone: 773-826-4065
  • Fax: 773-299-1019
Mailing address:
  • Phone: 773-826-4065
  • Fax: 773-299-1019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateIL

VIII. Authorized Official

Name: MR. DHIREN H SHAH
Title or Position: CFO
Credential:
Phone: 773-826-4065