Healthcare Provider Details

I. General information

NPI: 1053225854
Provider Name (Legal Business Name): THE SOCIETY FOR THE DANISH OLD PEOPLE'S HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5656 N NEWCASTLE AVE
CHICAGO IL
60631-3108
US

IV. Provider business mailing address

5656 N NEWCASTLE AVE
CHICAGO IL
60631-3108
US

V. Phone/Fax

Practice location:
  • Phone: 773-775-7383
  • Fax: 773-775-6922
Mailing address:
  • Phone: 773-775-7383
  • Fax: 773-775-6922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name: SCOTT SWANSON
Title or Position: PRESIDENT/CEO
Credential: ADMINISTRATOR
Phone: 773-775-7383