Healthcare Provider Details

I. General information

NPI: 1174175830
Provider Name (Legal Business Name): LAUREATE WEST CHICAGO OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2019
Last Update Date: 07/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

928 JOLIET ST
WEST CHICAGO IL
60185-3725
US

IV. Provider business mailing address

13024 BALNTYN CORP PL STE 425
CHARLOTTE NC
28277-4420
US

V. Phone/Fax

Practice location:
  • Phone: 630-231-9292
  • Fax: 630-231-6796
Mailing address:
  • Phone: 704-426-8849
  • 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: MR. SHAUN AHMAD
Title or Position: MANAGER
Credential:
Phone: 704-426-8849