Healthcare Provider Details

I. General information

NPI: 1609701895
Provider Name (Legal Business Name): MISERICORDIA HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 N RIDGE AVE
CHICAGO IL
60660-1099
US

IV. Provider business mailing address

6300 N RIDGE AVE
CHICAGO IL
60660-1099
US

V. Phone/Fax

Practice location:
  • Phone: 773-273-2038
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: KEVIN KNOLL
Title or Position: GENERAL COUNSEL/SECRETARY
Credential:
Phone: 773-273-2729