Healthcare Provider Details

I. General information

NPI: 1821439738
Provider Name (Legal Business Name): MERCY CIRCLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2013
Last Update Date: 01/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3659 W. 99TH STREET
CHICAGO IL
60655
US

IV. Provider business mailing address

3659 W 99TH STREET
CHICAGO IL
60655
US

V. Phone/Fax

Practice location:
  • Phone: 773-253-3600
  • Fax: 773-253-3700
Mailing address:
  • Phone: 773-253-3600
  • Fax: 773-253-3700

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: MARY F. VON GOEBEN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 773-617-1447