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General NPI Number Information
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NPI Number | 1194271825
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Entity Type | Organization
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Legal Business Name | VERONICA MACK
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Dates
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Enumeration Date | 09/01/2016
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Last Update Date | 09/01/2016
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Provider Practice Location Address
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Address Line | 9738 S MERRION AVE
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City | CHICAGO
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State | IL
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Zip | 60617-4846
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Country | US
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Telephone | 773-673-3960
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Fax |
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Provider Business Mailing Address
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Address Line | 9738 S MERRION
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City | CHICAGO
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State | IL
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Zip | 60617
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Country | US
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Telephone | 773-673-3960
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Fax |
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Authorized Official
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Title or Position | CNA
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Name | VERONICA MACK
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Credential | #0792-1021
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Telephone | 773-673-3960
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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 | 07921021
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License Number State | IL
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