Healthcare Provider Details

I. General information

NPI: 1891114856
Provider Name (Legal Business Name): PCHN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2014
Last Update Date: 09/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 NE 79TH TER
KANSAS CITY MO
64118-1564
US

IV. Provider business mailing address

7444 LONG AVE
SKOKIE IL
60077-3214
US

V. Phone/Fax

Practice location:
  • Phone: 816-436-8940
  • Fax:
Mailing address:
  • Phone: 847-329-4100
  • 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: BENJAMIN KLEIN
Title or Position: MANAGER
Credential:
Phone: 847-329-4100