Healthcare Provider Details

I. General information

NPI: 1386876050
Provider Name (Legal Business Name): THE CLARE AT WATER TOWER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2009
Last Update Date: 08/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 E PEARSON ST
CHICAGO IL
60611-2535
US

IV. Provider business mailing address

55 E PEARSON ST
CHICAGO IL
60611-2535
US

V. Phone/Fax

Practice location:
  • Phone: 312-784-8000
  • Fax: 312-951-5893
Mailing address:
  • Phone: 312-784-8000
  • Fax: 312-951-5893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0046789
License Number StateIL

VIII. Authorized Official

Name: MS. JUDY AMIANO
Title or Position: PRESIDENT & CEO
Credential:
Phone: 708-647-6500