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General NPI Number Information
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NPI Number | 1811018112
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Entity Type | Organization
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Legal Business Name | MONTGOMERY PLACE
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 03/03/2021
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Provider Practice Location Address
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Address Line | 5550 S SHORE DR
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City | CHICAGO
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State | IL
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Zip | 60637-5051
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Country | US
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Telephone | 773-753-4100
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Fax | 773-752-0056
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Provider Business Mailing Address
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Address Line | 5550 S SHORE DR
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City | CHICAGO
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State | IL
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Zip | 60637-5051
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Country | US
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Telephone | 773-753-4100
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Fax | 773-752-0056
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MS. DEBORAH E HART
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Credential |
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Telephone | 773-753-4096
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 0037515
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License Number State | IL
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