Healthcare Provider Details

I. General information

NPI: 1417496142
Provider Name (Legal Business Name): BEACON CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2017
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4538 N BEACON ST
CHICAGO IL
60640-5519
US

IV. Provider business mailing address

4538 N BEACON ST
CHICAGO IL
60640-5519
US

V. Phone/Fax

Practice location:
  • Phone: 773-275-7200
  • Fax: 773-275-7548
Mailing address:
  • Phone: 773-275-7200
  • Fax: 773-275-7548

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: MS. FRANCES MEEHAN
Title or Position: ATTORNEY
Credential: ESQ
Phone: 312-521-2467