Healthcare Provider Details

I. General information

NPI: 1003801093
Provider Name (Legal Business Name): BIRCHWOOD PLAZA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 11/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1426 W BIRCHWOOD AVE 1426 W. BIRCHWOOD AVE.
CHICAGO IL
60626-1807
US

IV. Provider business mailing address

1426 W BIRCHWOOD AVE 1426 W. BIRCHWOOD AVE.
CHICAGO IL
60626-1807
US

V. Phone/Fax

Practice location:
  • Phone: 773-274-4405
  • Fax: 773-274-4412
Mailing address:
  • Phone: 773-274-4405
  • Fax: 773-274-4412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0028696
License Number StateIL

VIII. Authorized Official

Name: MR. ABRAHAM SCHIFFMAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 773-274-4405