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General NPI Number Information
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NPI Number | 1023002318
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Entity Type | Organization
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Legal Business Name | PRESENCE SENIOR SERVICES CHICAGOLAND
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Dates
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Enumeration Date | 09/01/2005
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Last Update Date | 07/22/2024
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Provider Practice Location Address
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Address Line | 480 N WOLF RD
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City | NORTH LAKE
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State | IL
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Zip | 60164
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Country | US
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Telephone | 708-562-0040
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Fax | 708-562-5180
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Provider Business Mailing Address
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Address Line | 480 N WOLF RD
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City | NORTHLAKE
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State | IL
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Zip | 60164-1650
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Country | US
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Telephone | 708-562-0040
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Fax | 708-562-6623
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Authorized Official
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Title or Position | COO
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Name | KELLIE GRONEFELD
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Credential |
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Telephone | 314-729-3500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 0044792
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License Number State | IL
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