Healthcare Provider Details

I. General information

NPI: 1811018112
Provider Name (Legal Business Name): MONTGOMERY PLACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 S SHORE DR
CHICAGO IL
60637-5051
US

IV. Provider business mailing address

5550 S SHORE DR
CHICAGO IL
60637-5051
US

V. Phone/Fax

Practice location:
  • Phone: 773-753-4100
  • Fax: 773-752-0056
Mailing address:
  • Phone: 773-753-4100
  • Fax: 773-752-0056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number0037515
License Number StateIL

VIII. Authorized Official

Name: MS. DEBORAH E HART
Title or Position: PRESIDENT/CEO
Credential:
Phone: 773-753-4096