Healthcare Provider Details

I. General information

NPI: 1083664304
Provider Name (Legal Business Name): COMMUNITY CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4314 S WABASH AVE
CHICAGO IL
60653-3119
US

IV. Provider business mailing address

6865 N LINCOLN AVE
LINCOLNWOOD IL
60712-4611
US

V. Phone/Fax

Practice location:
  • Phone: 773-538-8300
  • Fax: 773-538-5775
Mailing address:
  • Phone: 847-674-5795
  • Fax: 847-674-5794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0029132
License Number StateIL

VIII. Authorized Official

Name: MR. AVRUM WEINFELD
Title or Position: CEO
Credential:
Phone: 847-674-5795