Healthcare Provider Details

I. General information

NPI: 1861664013
Provider Name (Legal Business Name): PIONEER GARDENS SENIOR HOUSING LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 04/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 S KING DR
CHICAGO IL
60653-1785
US

IV. Provider business mailing address

3800 S KING DR
CHICAGO IL
60653-1785
US

V. Phone/Fax

Practice location:
  • Phone: 773-420-4100
  • Fax: 773-536-0720
Mailing address:
  • Phone: 773-420-4100
  • Fax: 773-536-0720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. ANTHONY SHELL SR.
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 773-420-4101