Healthcare Provider Details

I. General information

NPI: 1316057318
Provider Name (Legal Business Name): CHICAGOLAND METHODIST SENIOR SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 W FOSTER AVE
CHICAGO IL
60640-2288
US

IV. Provider business mailing address

1415 W FOSTER AVE
CHICAGO IL
60640-2288
US

V. Phone/Fax

Practice location:
  • Phone: 773-769-5500
  • Fax: 773-769-6287
Mailing address:
  • Phone: 773-769-5500
  • Fax: 773-769-6287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1748898
License Number StateIL

VIII. Authorized Official

Name: FROILAN NUNEZ
Title or Position: CONTROLLER
Credential:
Phone: 773-596-2230