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General NPI Number Information
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NPI Number | 1821439738
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Entity Type | Organization
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Legal Business Name | MERCY CIRCLE
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Dates
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Enumeration Date | 07/09/2013
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Last Update Date | 01/23/2017
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Provider Practice Location Address
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Address Line | 3659 W. 99TH STREET
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City | CHICAGO
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State | IL
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Zip | 60655
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Country | US
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Telephone | 773-253-3600
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Fax | 773-253-3700
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Provider Business Mailing Address
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Address Line | 3659 W 99TH STREET
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City | CHICAGO
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State | IL
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Zip | 60655
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Country | US
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Telephone | 773-253-3600
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Fax | 773-253-3700
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MARY F. VON GOEBEN
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Credential |
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Telephone | 773-617-1447
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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 | IL
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