Healthcare Provider Details

I. General information

NPI: 1285796714
Provider Name (Legal Business Name): CARLTON AT THE LAKE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 W MONTROSE
CHICAGO IL
60613
US

IV. Provider business mailing address

725 W MONTROSE
CHICAGO IL
60613
US

V. Phone/Fax

Practice location:
  • Phone: 773-929-1700
  • Fax:
Mailing address:
  • Phone: 773-929-1700
  • Fax: 773-929-3068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JAMES T SLESUR
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CPA
Phone: 847-763-2550