Healthcare Provider Details

I. General information

NPI: 1891479895
Provider Name (Legal Business Name): RYZE ON THE AVENUE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 S INDIANA AVE
CHICAGO IL
60616-3841
US

IV. Provider business mailing address

3515 HOWARD ST STE 1001
SKOKIE IL
60076-4001
US

V. Phone/Fax

Practice location:
  • Phone: 312-842-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: EFRIAM WEINFELD
Title or Position: COO
Credential:
Phone: 773-557-0432