Healthcare Provider Details

I. General information

NPI: 1750378923
Provider Name (Legal Business Name): NORWEGIAN LUTHERAN BETHESDA HOME ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2833 N NORDICA AVE
CHICAGO IL
60634-4726
US

IV. Provider business mailing address

2833 N NORDICA AVE
CHICAGO IL
60634-4726
US

V. Phone/Fax

Practice location:
  • Phone: 773-622-6144
  • Fax: 773-622-8261
Mailing address:
  • Phone: 773-622-6144
  • Fax: 773-622-8261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0012229
License Number StateIL

VIII. Authorized Official

Name: MRS. JULIE BOGGESS
Title or Position: CEO
Credential: NHA
Phone: 773-622-6144