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General NPI Number Information
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NPI Number | 1508922683
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Entity Type | Organization
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Legal Business Name | THE OLD PEOPLE'S HOME OF THE CITY OF CHICAGO
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Dates
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Enumeration Date | 12/31/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 909 W FOSTER AVE
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City | CHICAGO
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State | IL
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Zip | 60640-6481
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Country | US
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Telephone | 773-654-5077
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Fax | 773-561-2573
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Provider Business Mailing Address
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Address Line | 1630 W MONTROSE AVE
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City | CHICAGO
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State | IL
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Zip | 60613-1214
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Country | US
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Telephone | 773-561-2900
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Fax | 773-561-2573
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. GLENN BRICHACEK
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Credential | PH.D.
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Telephone | 773-561-2900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number |
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License Number State | IL
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