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General NPI Number Information
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NPI Number | 1760851364
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Entity Type | Organization
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Legal Business Name | GOLDBLATTS OF CHICAGO LIMITED PARTNERSHIP
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Dates
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Enumeration Date | 09/24/2015
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Last Update Date | 08/28/2020
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Provider Practice Location Address
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Address Line | 4707 S MARSHFIELD AVE
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City | CHICAGO
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State | IL
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Zip | 60609-4159
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Country | US
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Telephone | 773-376-1223
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Fax | 773-376-1226
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Provider Business Mailing Address
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Address Line | 4707 S MARSHFIELD AVE
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City | CHICAGO
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State | IL
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Zip | 60609-4159
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Country | US
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Telephone | 773-376-1223
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Fax | 773-376-1226
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Authorized Official
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Title or Position | PRESIDENT OF MANAGEMENT AGENT
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Name | MRS. DEONA LEWIS THOMAS
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Credential |
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Telephone | 773-952-8004
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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 |
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License Number State | IL
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