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General NPI Number Information
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NPI Number | 1124987409
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Entity Type | Organization
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Legal Business Name | MISERICORDIA HOME
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Dates
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Enumeration Date | 01/21/2026
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Last Update Date | 01/21/2026
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Provider Practice Location Address
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Address Line | 6300 N RIDGE AVE
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City | CHICAGO
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State | IL
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Zip | 60660-1099
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Country | US
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Telephone | 773-973-6300
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Fax |
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Provider Business Mailing Address
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Address Line | 6300 N RIDGE AVE
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City | CHICAGO
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State | IL
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Zip | 60660-1099
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SECRETARY/GENERAL COUNSEL
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Name | KEVIN KNOLL
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Credential |
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Telephone | 773-273-2729
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State |
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