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General NPI Number Information
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NPI Number | 1346413879
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Entity Type | Organization
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Legal Business Name | ZACRE,LLC
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Dates
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Enumeration Date | 04/04/2008
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1996 FRANCISCAN WAY
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City | WEST CHICAGO
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State | IL
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Zip | 60185-6232
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Country | US
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Telephone | 630-562-4242
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Fax | 630-562-3593
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Provider Business Mailing Address
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Address Line | 1996 FRANCISCAN WAY
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City | WEST CHICAGO
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State | IL
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Zip | 60185-6232
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Country | US
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Telephone | 630-562-4242
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Fax | 630-562-3593
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ZACHARY CLARK CAULKINS
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Credential |
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Telephone | 630-562-4242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 001
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License Number State | IL
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