Healthcare Provider Details

I. General information

NPI: 1730173881
Provider Name (Legal Business Name): PRESENCE SENIOR SERVICES CHICAGOLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7370 W TALCOTT AVE
CHICAGO IL
60631-3751
US

IV. Provider business mailing address

7370 W TALCOTT AVE
CHICAGO IL
60631-3751
US

V. Phone/Fax

Practice location:
  • Phone: 773-594-7400
  • Fax: 773-594-7402
Mailing address:
  • Phone: 773-594-7400
  • Fax: 773-594-7402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0044354
License Number StateIL

VIII. Authorized Official

Name: ERIN SHADBOLT
Title or Position: COO
Credential:
Phone: 314-729-3500