Healthcare Provider Details

I. General information

NPI: 1780753269
Provider Name (Legal Business Name): MAYFIELD CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5905 W WASHINGTON BLVD
CHICAGO IL
60644-2845
US

IV. Provider business mailing address

3553 W PETERSON AVE SUITE 300
CHICAGO IL
60659-3200
US

V. Phone/Fax

Practice location:
  • Phone: 773-261-7074
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0029660
License Number StateIL

VIII. Authorized Official

Name: JOSHUA WEINSTEIN
Title or Position: ADMINISTRATOR
Credential:
Phone: 773-463-1313