Healthcare Provider Details

I. General information

NPI: 1205383346
Provider Name (Legal Business Name): URBANA BG OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 09/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 N WABASH AVE
CHICAGO IL
60611-3586
US

IV. Provider business mailing address

609 E. WATER ST.
URBANA OH
61802
US

V. Phone/Fax

Practice location:
  • Phone: 312-725-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: PETER TARSNEY
Title or Position: AUTHORIZED SIGNATORY
Credential:
Phone: 312-725-7000