Healthcare Provider Details

I. General information

NPI: 1780686758
Provider Name (Legal Business Name): MERIT LINCOLN PARK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date: 11/21/2006
Reactivation Date: 04/03/2007

III. Provider practice location address

550 W WEBSTER AVE
CHICAGO IL
60614-3965
US

IV. Provider business mailing address

550 W WEBSTER AVE
CHICAGO IL
60614-3965
US

V. Phone/Fax

Practice location:
  • Phone: 773-883-3800
  • Fax: 773-883-5168
Mailing address:
  • Phone: 773-883-3800
  • Fax: 773-883-5168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number0005256
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number1683805
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number0005256
License Number StateIL

VIII. Authorized Official

Name: MR. JOHN B ANSORGE
Title or Position: CFO
Credential:
Phone: 773-883-3809