Healthcare Provider Details

I. General information

NPI: 1407223183
Provider Name (Legal Business Name): CENRAL NURSING HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2015
Last Update Date: 08/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 N CENTRAL AVE
CHICAGO IL
60639-1316
US

IV. Provider business mailing address

6500 N HAMLIN AVE
LINCOLNWOOD IL
60712-3904
US

V. Phone/Fax

Practice location:
  • Phone: 773-889-1333
  • Fax:
Mailing address:
  • Phone: 847-679-7484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MARVIN MERMELSTEIN
Title or Position: PRESIDENT
Credential:
Phone: 847-679-7484